Provider Demographics
NPI:1053330522
Name:REED, WALTER WILLIAM III (MFT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:WILLIAM
Last Name:REED
Suffix:III
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:STANDARD
Mailing Address - State:CA
Mailing Address - Zip Code:95373-0301
Mailing Address - Country:US
Mailing Address - Phone:209-532-3569
Mailing Address - Fax:209-532-4086
Practice Address - Street 1:193 FAIRVIEW LN
Practice Address - Street 2:ST. D
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4828
Practice Address - Country:US
Practice Address - Phone:209-532-3569
Practice Address - Fax:209-532-4086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist