Provider Demographics
NPI:1962156349
Name:REAM, TAILER B (MA)
Entity type:Individual
Prefix:
First Name:TAILER
Middle Name:B
Last Name:REAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PARRYI CV
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4720
Mailing Address - Country:US
Mailing Address - Phone:417-274-8233
Mailing Address - Fax:
Practice Address - Street 1:113 PARRYI CV
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4720
Practice Address - Country:US
Practice Address - Phone:417-274-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional