Provider Demographics
NPI:1649480963
Name:REAMS, BENNIE PHILLIPS (EDD)
Entity type:Individual
Prefix:DR
First Name:BENNIE
Middle Name:PHILLIPS
Last Name:REAMS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 ANGELES VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1613
Mailing Address - Country:US
Mailing Address - Phone:323-291-2923
Mailing Address - Fax:323-291-2217
Practice Address - Street 1:3741 STOCKER STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5148
Practice Address - Country:US
Practice Address - Phone:323-298-0083
Practice Address - Fax:323-291-2217
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist