Provider Demographics
NPI:1760683486
Name:REED, LA SHARA MARIA (MS)
Entity Type:Individual
Prefix:MISS
First Name:LA SHARA
Middle Name:MARIA
Last Name:REED
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 COPPERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-2402
Mailing Address - Country:US
Mailing Address - Phone:601-572-3700
Mailing Address - Fax:
Practice Address - Street 1:805 S WHEATLEY ST
Practice Address - Street 2:SUITE 240
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5000
Practice Address - Country:US
Practice Address - Phone:601-572-3700
Practice Address - Fax:601-572-3701
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor