Provider Demographics
NPI:1114579679
Name:REEVES, CAITLIN ROSE (LCPC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ROSE
Last Name:REEVES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-3373
Mailing Address - Country:US
Mailing Address - Phone:309-339-1346
Mailing Address - Fax:
Practice Address - Street 1:3020 W WILLOW KNOLLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8127
Practice Address - Country:US
Practice Address - Phone:309-681-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional