Provider Demographics
NPI:1386762623
Name:VILES-REED, TERESA NADINE (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:NADINE
Last Name:VILES-REED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E CENTER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4648
Mailing Address - Country:US
Mailing Address - Phone:209-239-5553
Mailing Address - Fax:209-239-5978
Practice Address - Street 1:129 E. CENTER ST SUITE 3
Practice Address - Street 2:129 E. CENTER ST. SUITE 3
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8715
Practice Address - Country:US
Practice Address - Phone:209-239-5553
Practice Address - Fax:209-239-5978
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#PSY14848103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist