Provider Demographics
NPI:1497530794
Name:REEVE, DOMINIC ANDREW
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:ANDREW
Last Name:REEVE
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 1:2532 LILLIAN MILLER PKWY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2902
Mailing Address - Country:US
Mailing Address - Phone:185-578-2782
Mailing Address - Fax:
Practice Address - Street 1:2532 LILLIAN MILLER PKWY
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-2902
Practice Address - Country:US
Practice Address - Phone:185-578-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician