Provider Demographics
NPI:1497787782
Name:REED, CAROLYN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:B
Last Name:REED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6802
Mailing Address - Country:US
Mailing Address - Phone:325-944-4677
Mailing Address - Fax:325-947-2056
Practice Address - Street 1:3196 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6802
Practice Address - Country:US
Practice Address - Phone:325-944-4677
Practice Address - Fax:325-947-2056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DX13Medicare ID - Type Unspecified
TX00DX13Medicare UPIN