Provider Demographics
NPI:1417574237
Name:REEF WELLNESS
Entity Type:Organization
Organization Name:REEF WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:318-935-9585
Mailing Address - Street 1:10010 WILLOWWICK CT
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4521
Mailing Address - Country:US
Mailing Address - Phone:318-935-9585
Mailing Address - Fax:318-421-3193
Practice Address - Street 1:3616 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2122
Practice Address - Country:US
Practice Address - Phone:318-779-0104
Practice Address - Fax:318-421-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty