Provider Demographics
NPI:1053472969
Name:REED, JACK EDWARD (LPC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:EDWARD
Last Name:REED
Suffix:
Gender:M
Credentials:LPC
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 91025
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-1025
Mailing Address - Country:US
Mailing Address - Phone:512-450-0451
Mailing Address - Fax:
Practice Address - Street 1:4009 BANISTER LN # 369
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6853
Practice Address - Country:US
Practice Address - Phone:512-450-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAAC 1128-0080101YA0400X
TXLPC 16662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)