Provider Demographics
NPI:1457578338
Name:REED, LINDA WHITLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:WHITLEY
Last Name:REED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:K
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:6728 LOOP RD
Mailing Address - Street 2:BUILDIING 5 - SUITE 204
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2196
Mailing Address - Country:US
Mailing Address - Phone:937-433-5601
Mailing Address - Fax:937-433-5605
Practice Address - Street 1:6728 LOOP RD
Practice Address - Street 2:BUILDIING 5 - SUITE 204
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-2196
Practice Address - Country:US
Practice Address - Phone:937-433-5601
Practice Address - Fax:937-433-5605
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRECP24951Medicare ID - Type Unspecified