Provider Demographics
NPI:1356370761
Name:REED, THERESA M (PHD PC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:REED
Suffix:
Gender:F
Credentials:PHD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W FRONT ST
Mailing Address - Street 2:STE 309
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4011
Mailing Address - Country:US
Mailing Address - Phone:406-327-6663
Mailing Address - Fax:406-327-9987
Practice Address - Street 1:119 W FRONT ST
Practice Address - Street 2:STE 309
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4011
Practice Address - Country:US
Practice Address - Phone:406-327-6663
Practice Address - Fax:406-327-9987
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000052191OtherBC/BS
MT0492082Medicaid
MT52191OtherMEDICARE ADVANTAGE
P96190Medicare UPIN
MT000050180Medicare PIN