Provider Demographics
NPI:1225641210
Name:REEDER, CHANNEL MALISSA (LMHC)
Entity Type:Individual
Prefix:
First Name:CHANNEL
Middle Name:MALISSA
Last Name:REEDER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3358
Mailing Address - Country:US
Mailing Address - Phone:646-322-9349
Mailing Address - Fax:
Practice Address - Street 1:31 MEADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3358
Practice Address - Country:US
Practice Address - Phone:646-322-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007559-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health