Provider Demographics
NPI:1548656804
Name:REID PROFESSIONAL COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:REID PROFESSIONAL COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AVIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-334-8807
Mailing Address - Street 1:118 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-7961
Mailing Address - Country:US
Mailing Address - Phone:405-334-8807
Mailing Address - Fax:
Practice Address - Street 1:2917 CHRISTINA CT
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3009
Practice Address - Country:US
Practice Address - Phone:405-334-8807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty