Provider Demographics
NPI:1245436757
Name:REEVES, DEBORA K (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:K
Last Name:REEVES
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 DIEDERICH BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1719
Mailing Address - Country:US
Mailing Address - Phone:606-834-0020
Mailing Address - Fax:606-834-0049
Practice Address - Street 1:1448 DIEDERICH BLVD
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169
Practice Address - Country:US
Practice Address - Phone:606-834-0020
Practice Address - Fax:606-834-0049
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0754101YA0400X
KY36451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100349280Medicaid
Y3645OtherTHE HEALTH PLAN (OF WV AND OH)
2335893OtherCOMPSYCH
11659832OtherCAQH
000000363272OtherANTHEM BCBS
KY1364869OtherWELLCARE OF KENTUCKY
KYK178741OtherMEDICARE PTAN
YA-73697OtherANTHEM EAP
292233000OtherMAGELLAN - MIS
4995354OtherCIGNA