Provider Demographics
NPI:1174789580
Name:REED, TINA M (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:REED
Suffix:
Gender:F
Credentials:MA, LPC
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 904
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:MO
Mailing Address - Zip Code:63965-0904
Mailing Address - Country:US
Mailing Address - Phone:573-323-8796
Mailing Address - Fax:573-323-0377
Practice Address - Street 1:#4 SOUTHWEST STREET
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:MO
Practice Address - Zip Code:63965-0904
Practice Address - Country:US
Practice Address - Phone:573-323-8796
Practice Address - Fax:573-323-0377
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493947006Medicaid