Provider Demographics
NPI:1477195451
Name:THOMAS, JACQUELINE REEVES (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:REEVES
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 GOOSE CREEK DR APT 103
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-1834
Mailing Address - Country:US
Mailing Address - Phone:301-613-5064
Mailing Address - Fax:
Practice Address - Street 1:MEMPHIS VETERANS AFFAIRS MEDICAL CENTER (VAMC)
Practice Address - Street 2:1030 JEFFERSON AVE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38016
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000004507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional