MEDICARE: PHYLLIS M REESMAN LCSW

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	101Y00000X	Counselor	000596	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538204904	OTHER	MO	BOONVILLE NPI
2	3361	OTHER	MO	FEI I.D. NUMBER
3	5763918	OTHER	MO	FIRST HEALTH I.D. NUMBER
4	1649269622	OTHER	MO	GROUP BILLING NPI
5	203147	OTHER	MO	HEALTHLINK I.D. NUMBER
6	22157	OTHER	MO	BCBS I.D. NUMBER

General Provider Information

NPI Number	:	1902806581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS M REESMAN LCSW

Provider Business Mailing Address
First Line	:	117 N GARTH AVE
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-4103
Country	:	US
Telephone Number	:	573-443-2204
Fax Number	:	573-875-5851

Provider Business Practice Location Address
First Line	:	15899 LOGANS LAKE RD
Second Line	:
City	:	BOONVILLE
State	:	MO
Zip	:	65233-2866
Country	:	US
Telephone Number	:	660-882-2333
Fax Number	:	550-882-2333

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/13/2007

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Directions to “ PHYLLIS M REESMAN LCSW” Practice Location

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