Basic Information
Provider Information
NPI: 1538259759
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REED
FirstName: DANNY
MiddleName: PAUL
NamePrefix: MR.
NameSuffix:  
Credential: M.A., L.P.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9773 E CLARENCE RD
Address2:  
City: HARRISON
State: MI
PostalCode: 486259038
CountryCode: US
TelephoneNumber: 9895397434
FaxNumber:  
Practice Location
Address1: 655 E CEDAR AVE
Address2:  
City: GLADWIN
State: MI
PostalCode: 486242215
CountryCode: US
TelephoneNumber: 9894269295
FaxNumber: 9894262251
Other Information
ProviderEnumerationDate: 10/16/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X6401005494MIY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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