MEDICARE: ROBERT JESSE REED MS, LPC/CMHC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	60697	TX
2	101YP2500X	Professional Counselor	8111684-6004	UT

General Provider Information

NPI Number	:	1215056247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JESSE REED MS, LPC/CMHC

Provider Business Mailing Address
First Line	:	PO BOX 6332
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84402-6332
Country	:	US
Telephone Number	:	888-801-1556
Fax Number	:	877-544-4630

Provider Business Practice Location Address
First Line	:	2909 WASHINGTON BLVD
Second Line	:	SUITE 101
City	:	OGDEN
State	:	UT
Zip	:	84401-3744
Country	:	US
Telephone Number	:	888-801-1556
Fax Number	:	877-544-4630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	09/08/2016

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