Provider Demographics
NPI:1093926123
Name:REED, JUSTIN W
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:W
Last Name:REED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 MADRAS ST SE APT 3060
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2275
Mailing Address - Country:US
Mailing Address - Phone:503-551-8759
Mailing Address - Fax:
Practice Address - Street 1:ACADEMY BUILDING
Practice Address - Street 2:182 S.W. ACADEMY ST. SUITE 304
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:503-831-1726
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health