Provider Demographics
NPI:1770026064
Name:REID, CHUCK (PHD)
Entity Type:Individual
Prefix:
First Name:CHUCK
Middle Name:
Last Name:REID
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 S CLOSNER BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7176
Mailing Address - Country:US
Mailing Address - Phone:956-502-5200
Mailing Address - Fax:
Practice Address - Street 1:108 N. JACKSON RD
Practice Address - Street 2:SUITE 32
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541
Practice Address - Country:US
Practice Address - Phone:956-609-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00016288101YM0800X
TX14150426101YM0800X
TX13650101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health