Provider Demographics
NPI:1306015482
Name:REA, JOSEPH M (MA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:REA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 W CHERYL DR
Mailing Address - Street 2:SUITE A-255
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9578
Mailing Address - Country:US
Mailing Address - Phone:602-548-8508
Mailing Address - Fax:602-548-1201
Practice Address - Street 1:3404 W CHERYL DR
Practice Address - Street 2:SUITE A-255
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9578
Practice Address - Country:US
Practice Address - Phone:602-548-8508
Practice Address - Fax:602-548-1201
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-12728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional