Provider Demographics
NPI:1811697386
Name:REED, VINCENT ARTHUR (MA, AMFT)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:ARTHUR
Last Name:REED
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4397
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91617-0397
Mailing Address - Country:US
Mailing Address - Phone:301-580-5077
Mailing Address - Fax:
Practice Address - Street 1:3101 OCEAN PARK BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3022
Practice Address - Country:US
Practice Address - Phone:301-580-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA129400OtherAMFT REGISTRATION NUMBER