Provider Demographics
NPI:1750855664
Name:KIMBERLY REEVAS, LLC
Entity Type:Organization
Organization Name:KIMBERLY REEVAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:574-904-8552
Mailing Address - Street 1:489 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1003
Mailing Address - Country:US
Mailing Address - Phone:574-904-8552
Mailing Address - Fax:
Practice Address - Street 1:20500 S LAGRANGE RD STE 200S
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1901
Practice Address - Country:US
Practice Address - Phone:574-904-8552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)