Provider Demographics
NPI:1477854305
Name:REEVES, CLINTON LEE (L P C)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:LEE
Last Name:REEVES
Suffix:
Gender:M
Credentials:L P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BROOKWOOD BLVD
Mailing Address - Street 2:101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6801
Mailing Address - Country:US
Mailing Address - Phone:205-803-2210
Mailing Address - Fax:205-803-2214
Practice Address - Street 1:509 BROOKWOOD BLVD
Practice Address - Street 2:101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6801
Practice Address - Country:US
Practice Address - Phone:205-803-2210
Practice Address - Fax:205-803-2214
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional