Provider Demographics
NPI:1447285515
Name:REID, JOHN KENNETH (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNETH
Last Name:REID
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16414 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 545
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2277
Mailing Address - Country:US
Mailing Address - Phone:210-495-7733
Mailing Address - Fax:210-497-5450
Practice Address - Street 1:16414 SAN PEDRO AVE
Practice Address - Street 2:SUITE 545
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2277
Practice Address - Country:US
Practice Address - Phone:210-495-7733
Practice Address - Fax:210-497-5450
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1444103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist