Provider Demographics
NPI:1093243966
Name:REEVES, MONICA SUE (MED)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:SUE
Last Name:REEVES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MCCLEARY RD
Mailing Address - Street 2:
Mailing Address - City:MCCLEARY
Mailing Address - State:WA
Mailing Address - Zip Code:98557-9301
Mailing Address - Country:US
Mailing Address - Phone:360-470-0536
Mailing Address - Fax:
Practice Address - Street 1:28 MCCLEARY RD
Practice Address - Street 2:
Practice Address - City:MCCLEARY
Practice Address - State:WA
Practice Address - Zip Code:98557-9301
Practice Address - Country:US
Practice Address - Phone:360-470-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60713398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health