MEDICARE: MR. TERRY WILLIAM REESE LPC, CSAC

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	6596-125	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	16225132	WI

General Provider Information

NPI Number	:	1528572518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY WILLIAM REESE LPC, CSAC

Provider Business Mailing Address
First Line	:	412 E LONGVIEW DR STE C
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-2168
Country	:	US
Telephone Number	:	920-382-3340
Fax Number	:	920-325-0198

Provider Business Practice Location Address
First Line	:	412 E LONGVIEW DR STE C
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-2168
Country	:	US
Telephone Number	:	920-238-3340
Fax Number	:	920-325-0198

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

Provider Enumeration Date	:	11/29/2017
Last Update Date	:	04/06/2023

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