Provider Demographics
NPI:1902942303
Name:REID, PATRICK JAMES (MS)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JAMES
Last Name:REID
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1604 HUNTWOOD PARK CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3998
Mailing Address - Country:US
Mailing Address - Phone:248-366-2411
Mailing Address - Fax:734-432-6077
Practice Address - Street 1:17177 N LAUREL PARK DR
Practice Address - Street 2:SUITE 437
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2693
Practice Address - Country:US
Practice Address - Phone:734-432-6066
Practice Address - Fax:734-432-6077
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist