Provider Demographics
NPI:1942720685
Name:REEVES, SARAH R (MS, TLLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:REEVES
Suffix:
Gender:F
Credentials:MS, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 MILL ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2231
Mailing Address - Country:US
Mailing Address - Phone:313-205-5238
Mailing Address - Fax:
Practice Address - Street 1:8565 N SILVERY LN STE 400
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4518
Practice Address - Country:US
Practice Address - Phone:734-489-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 247000000X
MI6362008880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information