Provider Demographics
NPI:1609313501
Name:MAXWELL, REED (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:REED
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GRAND BLVD APT 207
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-1685
Mailing Address - Country:US
Mailing Address - Phone:913-387-7987
Mailing Address - Fax:
Practice Address - Street 1:501 GRAND BLVD APT 207
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-1685
Practice Address - Country:US
Practice Address - Phone:913-387-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2021031965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program