Provider Demographics
NPI:1104440429
Name:REESE, RODNEY KENT (MA LPC)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:KENT
Last Name:REESE
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 BATTERY PARK
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2810
Mailing Address - Country:US
Mailing Address - Phone:210-722-5843
Mailing Address - Fax:
Practice Address - Street 1:4227 BATTERY PARK
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2810
Practice Address - Country:US
Practice Address - Phone:210-722-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional