Provider Demographics
NPI:1548653066
Name:REA, JOSEPH (LLP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:REA
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2749
Mailing Address - Country:US
Mailing Address - Phone:517-265-5352
Mailing Address - Fax:517-263-6090
Practice Address - Street 1:220 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2749
Practice Address - Country:US
Practice Address - Phone:517-265-5352
Practice Address - Fax:517-263-6090
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015223103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist