Provider Demographics
NPI:1154946275
Name:READ, MARK TRUMAN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:TRUMAN
Last Name:READ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3286
Mailing Address - Country:US
Mailing Address - Phone:833-222-4273
Mailing Address - Fax:
Practice Address - Street 1:950 W MONROE ST STE G600
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2171
Practice Address - Country:US
Practice Address - Phone:517-795-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician