MEDICARE: SANDY REESON

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	103K00000X	Behavior Analyst	2653	TX

General Provider Information

NPI Number	:	1417406281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY REESON

Provider Business Mailing Address
First Line	:	5040 CASSIDY LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9171
Country	:	US
Telephone Number	:	830-399-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	773 BANDIT TRL
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-0111
Country	:	US
Telephone Number	:	830-399-5364
Fax Number	:

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

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	06/16/2025

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Directions to “ SANDY REESON ” Practice Location

Language	Start Address	Practice Location

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