Provider Demographics
NPI:1952508558
Name:REID, ANGELA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N JEFFERSON AVE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-1108
Mailing Address - Country:US
Mailing Address - Phone:417-343-4410
Mailing Address - Fax:
Practice Address - Street 1:309 N JEFFERSON AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1108
Practice Address - Country:US
Practice Address - Phone:417-343-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029883103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist