MEDICARE: SUSAN D REIS & ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TB0200X	Cognitive & Behavioral Psychologist
2	103TC0700X	Clinical Psychologist
3	103TC1900X	Counseling Psychologist
4	103TF0000X	Family Psychologist
5	106H00000X	Marriage & Family Therapist
6	103T00000X	Psychologist

General Provider Information

NPI Number	:	1184933137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN D REIS & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	5131 LEMAY FERRY ROAD
Second Line	:
City	:	ST,. LOUIS
State	:	MO
Zip	:	63129
Country	:	US
Telephone Number	:	314-416-0094
Fax Number	:	314-846-3531

Provider Business Practice Location Address
First Line	:	5131 LEMAY FERRY ROAD
Second Line	:
City	:	ST,. LOUIS
State	:	MO
Zip	:	63129
Country	:	US
Telephone Number	:	314-416-0094
Fax Number	:	314-846-3531

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. SUSAN REIS
Credential	:	PH.D.
Telephone Number	:	314-416-0094

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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