Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 174688 | KY |
N | 103T00000X | Psychologist | 174688 | KY |
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 265760 | KY |
N | 103G00000X | Clinical Psychologist | 174688 | KY |
N | 103TC0700X | Clinical Psychologist | 174688 | KY |
NPI | 1033619986 |
---|---|
Provider Name | Michael Gale Reeser II |
First Address | Erlanger, KY 41018 |
Second Address | Erlanger, KY 41018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2018 |
Last Update Date | 27/10/2020 |