MEDICARE: STEPHANIE REESE MA, 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
1	101YM0800X	Mental Health Counselor	10325	TX

General Provider Information

NPI Number	:	1790900496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE REESE MA, LPC

Provider Business Mailing Address
First Line	:	4901 BROADWAY ST STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5734
Country	:	US
Telephone Number	:	210-822-5795
Fax Number	:	210-822-5939

Provider Business Practice Location Address
First Line	:	4901 BROADWAY ST STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5734
Country	:	US
Telephone Number	:	210-822-5795
Fax Number	:	210-822-5939

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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