Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0810005632 | VA |
NPI | 1003055849 |
---|---|
Provider Name | Dr. Ryan N Reed |
First Address | Twentynine Palms, CA 92278 |
Second Address | Twentynine Palms, CA 92278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2009 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0810005632 | PSYCHOLOGY LICENSE (01) | VA |