Provider Demographics
NPI:1114570363
Name:REEVES, ANGELA M (MASTER SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:REEVES
Suffix:
Gender:F
Credentials:MASTER SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 GEORGE WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4418
Mailing Address - Country:US
Mailing Address - Phone:445-208-6985
Mailing Address - Fax:
Practice Address - Street 1:444 3RD AVE N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5909
Practice Address - Country:US
Practice Address - Phone:208-308-9347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID834003075Medicaid
ID1114570363Medicaid