Provider Demographics
NPI:1225899800
Name:REED, JUANITA MARIE (ACLC)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:MARIE
Last Name:REED
Suffix:
Gender:F
Credentials:ACLC
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 1179
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-1179
Mailing Address - Country:US
Mailing Address - Phone:406-872-0630
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2731
Practice Address - Country:US
Practice Address - Phone:406-872-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT67268101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)