Provider Demographics
NPI:1922779123
Name:REED, MONIQUE
Entity Type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14420 CIVIC DR STE 6
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2384
Mailing Address - Country:US
Mailing Address - Phone:760-253-1834
Mailing Address - Fax:760-267-1909
Practice Address - Street 1:14420 CIVIC DR STE 6
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2384
Practice Address - Country:US
Practice Address - Phone:760-253-1834
Practice Address - Fax:760-267-1909
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist