Provider Demographics
NPI:1578637054
Name:REID, JON KENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:KENT
Last Name:REID
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 PECAN GROVE RD E
Mailing Address - Street 2:CHILD AND FAMILY GUIDANCE CENTER
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1767
Mailing Address - Country:US
Mailing Address - Phone:903-893-7768
Mailing Address - Fax:903-893-4979
Practice Address - Street 1:804 PECAN GROVE RD E
Practice Address - Street 2:CHILD AND FAMILY GUIDANCE CENTER
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1767
Practice Address - Country:US
Practice Address - Phone:903-893-7768
Practice Address - Fax:903-893-4979
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025751104Medicaid
TX025751102Medicaid