Provider Demographics
NPI:1922345651
Name:REVES, MICKEY (LPC INTERN)
Entity Type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:
Last Name:REVES
Suffix:
Gender:M
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 LILLIAN MILLER PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-7206
Mailing Address - Country:US
Mailing Address - Phone:940-383-1207
Mailing Address - Fax:214-292-8512
Practice Address - Street 1:2524 LILLIAN MILLER PKWY STE 115
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7206
Practice Address - Country:US
Practice Address - Phone:940-383-1207
Practice Address - Fax:214-292-8512
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional