Provider Demographics
NPI:1528565876
Name:REESE, KIP (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 BOYER AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2502
Mailing Address - Country:US
Mailing Address - Phone:509-540-9786
Mailing Address - Fax:
Practice Address - Street 1:19 E BIRCH ST STE 105
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3205
Practice Address - Country:US
Practice Address - Phone:509-540-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60646425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health