Individual
MR. EDWARD WILLIAM REICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH,D,
Contact information
Practice address
1440 N HARBOR BLVD, SUITE 127, FULLERTON, CA 92835-4114
(714) 879-7091
(714) 441-0914
Mailing address
1440 N HARBOR BLVD, SUITE 127, FULLERTON, CA 92835-4127
(714) 879-7091
(714) 441-0914
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 11010
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CP11010
—
CA
01
—
OPL 11010
USBH
CA
01
—
PSY 11010
STATE LICENSE
CA
05
—
PSY11010
—
CA
Enumeration date
01/22/2007
Last updated
02/02/2012
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