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NPI Code Detail

MEDICARE: MR. MARION DONEL REEDUS II

MEDICARE: MR. MARION DONEL REEDUS II
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1801144308
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARION DONEL REEDUS II
Provider Business Mailing Address
First Line : 2726 GARDEN ST
Second Line :
City : OAKLAND
State : CA
Zip : 94601-1314
Country : US
Telephone Number : 510-302-8951
Fax Number :
Provider Business Practice Location Address
First Line : 2726 GARDEN ST
Second Line :
City : OAKLAND
State : CA
Zip : 94601-1314
Country : US
Telephone Number : 510-302-8951
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2012
Last Update Date : 08/15/2012

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Directions to “ MR. MARION DONEL REEDUS II ” Practice Location

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