Provider Demographics
NPI:1174951768
Name:REED, KATELYN MARIE (MS, TLLP)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARIE
Last Name:REED
Suffix:
Gender:F
Credentials:MS, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10327 GRAND RIVER RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6500
Mailing Address - Country:US
Mailing Address - Phone:810-225-3417
Mailing Address - Fax:
Practice Address - Street 1:10327 GRAND RIVER RD
Practice Address - Street 2:SUITE 406
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6500
Practice Address - Country:US
Practice Address - Phone:810-225-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015577103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent