Provider Demographics
NPI:1598240160
Name:REEVES, TRACY A (LMFT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:REEVES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-1937
Mailing Address - Country:US
Mailing Address - Phone:707-410-0606
Mailing Address - Fax:
Practice Address - Street 1:1443 MAIN ST STE C220
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1928
Practice Address - Country:US
Practice Address - Phone:707-410-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist