Provider Demographics
NPI:1912559097
Name:REED, MICHAEL ALBERT (DPC, EDS,MIT,BS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALBERT
Last Name:REED
Suffix:
Gender:M
Credentials:DPC, EDS,MIT,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 KRISTEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2831
Mailing Address - Country:US
Mailing Address - Phone:601-212-4854
Mailing Address - Fax:
Practice Address - Street 1:787 E NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4945
Practice Address - Country:US
Practice Address - Phone:769-524-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS201130102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst