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NPI Code Detail

MEDICARE: REESE BOYD LPC

MEDICARE: REESE BOYD LPC
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
1390200000XStudent in an Organized Health Care Education/Training ProgramC.2002868-TRNEOH
2101YM0800XMental Health CounselorC.2204603OH

General Provider Information

NPI Number : 1780279497
Entity Type Code : Individual
Provider Name (Legal Business Name) : REESE BOYD LPC
Provider Business Mailing Address
First Line : 761 PROVIDENCE CT APT 302
Second Line :
City : STREETSBORO
State : OH
Zip : 44241-4036
Country : US
Telephone Number : 740-296-1889
Fax Number :
Provider Business Practice Location Address
First Line : 23412 COMMERCE PARK
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5813
Country : US
Telephone Number : 216-400-6640
Fax Number : 216-250-7016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2021
Last Update Date : 10/14/2024

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