Provider Demographics
NPI:1760884548
Name:REESE, ADAM (PP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 CHELSEA CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2718
Mailing Address - Country:US
Mailing Address - Phone:706-442-3727
Mailing Address - Fax:
Practice Address - Street 1:3390 CHELSEA CIR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2718
Practice Address - Country:US
Practice Address - Phone:706-442-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor