Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 83131 | TX |
NPI | 1003589839 |
---|---|
Provider Name | Ian Michael Reeder |
First Address | San Antonio, TX 78229-3558 |
Second Address | San Antonio, TX 78229-3558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |