Provider Demographics
NPI:1336550458
Name:HOWARD, REGINALD LEON SR (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:LEON
Last Name:HOWARD
Suffix:SR
Gender:M
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GOODALE AVE E
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2726
Mailing Address - Country:US
Mailing Address - Phone:616-356-1746
Mailing Address - Fax:616-356-1810
Practice Address - Street 1:26 GOODALE AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-2726
Practice Address - Country:US
Practice Address - Phone:616-356-1746
Practice Address - Fax:616-356-1810
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist