Provider Demographics
NPI:1649776550
Name:REECE, LIALA MARYANN
Entity type:Individual
Prefix:
First Name:LIALA
Middle Name:MARYANN
Last Name:REECE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S WASHINGTON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3833
Mailing Address - Country:US
Mailing Address - Phone:248-629-0044
Mailing Address - Fax:
Practice Address - Street 1:306 S WASHINGTON AVE STE 205
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3833
Practice Address - Country:US
Practice Address - Phone:248-629-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional