Provider Demographics
NPI:1992212567
Name:REED, MARCIE
Entity Type:Individual
Prefix:
First Name:MARCIE
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 1:7373 UNIVERSITY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0524
Mailing Address - Country:US
Mailing Address - Phone:619-713-0737
Mailing Address - Fax:619-639-8277
Practice Address - Street 1:7373 UNIVERSITY AVE STE 202
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0524
Practice Address - Country:US
Practice Address - Phone:619-713-0737
Practice Address - Fax:619-639-8277
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17-35109103K00000X, 106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst