Provider Demographics
NPI:1215056247
Name:REED, ROBERT JESSE (MS, LPC/CMHC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JESSE
Last Name:REED
Suffix:
Gender:M
Credentials:MS, LPC/CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6332
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84402-6332
Mailing Address - Country:US
Mailing Address - Phone:888-801-1556
Mailing Address - Fax:877-544-4630
Practice Address - Street 1:2909 WASHINGTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3744
Practice Address - Country:US
Practice Address - Phone:888-801-1556
Practice Address - Fax:877-544-4630
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60697101YP2500X
UT8111684-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional