1730568098 NPI number — MRS. BLYTHE VALENCIA REICH M. ED.

Table of content: MRS. BLYTHE VALENCIA REICH M. ED. (NPI 1730568098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730568098 NPI number — MRS. BLYTHE VALENCIA REICH M. ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REICH
Provider First Name:
BLYTHE
Provider Middle Name:
VALENCIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M. ED.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730568098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 NEEDMORE RD
Provider Second Line Business Mailing Address:
UNIT 22
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37040-6275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 VILLAGE SQ
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PLEASANT VIEW
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37146-7178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-880-5714
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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