Provider Demographics
NPI:1528572518
Name:REESE, TERRY WILLIAM (LPC, CSAC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:WILLIAM
Last Name:REESE
Suffix:
Gender:M
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E LONGVIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2168
Mailing Address - Country:US
Mailing Address - Phone:920-382-3340
Mailing Address - Fax:920-325-0198
Practice Address - Street 1:412 E LONGVIEW DR STE C
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2168
Practice Address - Country:US
Practice Address - Phone:920-238-3340
Practice Address - Fax:920-325-0198
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6596-125101YP2500X
WI16225132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)