Provider Demographics
NPI:1184213142
Name:REEVES, STEPHANIE SHAWN (LCPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SHAWN
Last Name:REEVES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SHAWN
Other - Last Name:ASPLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:410 S LAVINA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1145
Mailing Address - Country:US
Mailing Address - Phone:208-719-1854
Mailing Address - Fax:
Practice Address - Street 1:120 E LAKE ST STE 305
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1366
Practice Address - Country:US
Practice Address - Phone:208-719-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1184213142OtherBLUE CROSS
ID1184213142Medicaid
ID1184213142OtherUBH