Provider Demographics
NPI:1164672465
Name:REID, JANICE KAY (LADC UNDER SUPERVISI)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:KAY
Last Name:REID
Suffix:
Gender:F
Credentials:LADC UNDER SUPERVISI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-1256
Mailing Address - Country:US
Mailing Address - Phone:580-233-7200
Mailing Address - Fax:
Practice Address - Street 1:2605 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1713
Practice Address - Country:US
Practice Address - Phone:580-233-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)