Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 20041757A | IN |
Y | 103TC0700X | Clinical Psychologist | 20041757A | IN |
NPI | 1275057705 |
---|---|
Provider Name | Dr. Christine Reese |
First Address | Lansing, IL 60438-6628 |
Second Address | Calumet Park, IL 60643-5401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2017 |
Last Update Date | 21/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366075566 | NPI (01) | IL |
1912992819 | NPI (01) | IN |
200136790 | (05) | IN |
300056709 | (05) | IN |