Provider Demographics
NPI:1952396558
Name:REED, PHILIP RICHARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RICHARD
Last Name:REED
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1600
Mailing Address - Country:US
Mailing Address - Phone:505-889-4538
Mailing Address - Fax:505-889-4514
Practice Address - Street 1:3200 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 121
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1600
Practice Address - Country:US
Practice Address - Phone:505-889-4538
Practice Address - Fax:505-889-4514
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical