Provider Demographics
NPI:1245362151
Name:REEVES, ANN WEILER
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:WEILER
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0378
Mailing Address - Country:US
Mailing Address - Phone:928-729-2374
Mailing Address - Fax:928-729-6730
Practice Address - Street 1:NAVAJO ROUTE 12
Practice Address - Street 2:WINDOW ROCK SCHOOLS
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-0559
Practice Address - Country:US
Practice Address - Phone:928-729-6760
Practice Address - Fax:928-729-6730
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30643103TS0200X
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ653247OtherAHCCCS