Provider Demographics
NPI:1346682366
Name:THOMAS, REAVOUS J
Entity Type:Individual
Prefix:
First Name:REAVOUS
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MARTIN LUTHER KING BLVD
Mailing Address - Street 2:2133
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4314
Mailing Address - Country:US
Mailing Address - Phone:702-601-8791
Mailing Address - Fax:
Practice Address - Street 1:100 S MARTIN LUTHER KING BLVD
Practice Address - Street 2:2133
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4314
Practice Address - Country:US
Practice Address - Phone:702-601-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service