Provider Demographics
NPI:1053476515
Name:REICH, MARK WILLIAM (MS PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WILLIAM
Last Name:REICH
Suffix:
Gender:M
Credentials:MS PSYCHOLOGY
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Mailing Address - Street 1:W2510 VALLEYWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-788-5261
Mailing Address - Fax:
Practice Address - Street 1:103 WEST COLLEGE AVENUE
Practice Address - Street 2:SUITE 815
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-733-1992
Practice Address - Fax:920-733-1866
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2551123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health