Basic Information
| Provider Information | |||||||||
| NPI: | 1093918385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REICH | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC-MHSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7305 JARNIGAN ROAD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374214874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954345 | ||||||||
| FaxNumber: | 4234954934 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 E MAIN STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236432246 | ||||||||
| FaxNumber: | 4236432030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 02/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0485 | KY | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPC0000003565 | TN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 30615058 | 05 | KY | MEDICAID |