Provider Demographics
NPI:1528397726
Name:REAVES, SHELLY (LPC, LADAC, MAC, SAP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:REAVES
Suffix:
Gender:F
Credentials:LPC, LADAC, MAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 SE MOBERLY LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7015
Mailing Address - Country:US
Mailing Address - Phone:479-422-4657
Mailing Address - Fax:
Practice Address - Street 1:1732 SE MOBERLY LN
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7015
Practice Address - Country:US
Practice Address - Phone:479-422-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1211111101YP2500X
AR356L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)