Provider Demographics
NPI:1093586893
Name:REED, REVA L (MED LMFT, CEO)
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:L
Last Name:REED
Suffix:
Gender:F
Credentials:MED LMFT, CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SW 78TH AVE APT 719
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3487
Mailing Address - Country:US
Mailing Address - Phone:407-457-0637
Mailing Address - Fax:407-457-0637
Practice Address - Street 1:730 SW 78TH AVE APT 719
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3487
Practice Address - Country:US
Practice Address - Phone:786-737-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist