Provider Demographics
NPI:1144885583
Name:REESE, DEANGELA
Entity type:Individual
Prefix:
First Name:DEANGELA
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 BELLEVIEW ST APT 334
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-2241
Mailing Address - Country:US
Mailing Address - Phone:817-908-7404
Mailing Address - Fax:
Practice Address - Street 1:1414 BELLEVIEW ST APT 334
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2241
Practice Address - Country:US
Practice Address - Phone:817-908-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83-4598265Medicaid