Provider Demographics
NPI:1760835193
Name:REESE, MATTHEW (EDS)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S SPLITROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1652
Mailing Address - Country:US
Mailing Address - Phone:605-582-3446
Mailing Address - Fax:605-582-3229
Practice Address - Street 1:300 S SPLITROCK BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1652
Practice Address - Country:US
Practice Address - Phone:605-582-3446
Practice Address - Fax:605-582-3229
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD61777-4103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist