Provider Demographics
NPI:1689185571
Name:REED-TSO, JULLLIENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULLLIENE
Middle Name:
Last Name:REED-TSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JULLIENE (JAY)
Other - Middle Name:
Other - Last Name:REED-TSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049-0219
Mailing Address - Country:US
Mailing Address - Phone:505-552-5500
Mailing Address - Fax:505-552-5530
Practice Address - Street 1:NEW SUNRISE RTC 20 MOCKINGBIRD DRIVE
Practice Address - Street 2:
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049
Practice Address - Country:US
Practice Address - Phone:505-552-5500
Practice Address - Fax:505-552-5530
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-08561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical