Provider Demographics
NPI:1447885801
Name:REESE, ROY C JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:C
Last Name:REESE
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12247 S RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5401
Mailing Address - Country:US
Mailing Address - Phone:312-687-0198
Mailing Address - Fax:
Practice Address - Street 1:12247 S RACINE AVE
Practice Address - Street 2:
Practice Address - City:CALUMET PARK
Practice Address - State:IL
Practice Address - Zip Code:60643-5401
Practice Address - Country:US
Practice Address - Phone:312-687-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner