Provider Demographics
NPI:1457704058
Name:REEVES, TEDDY
Entity Type:Individual
Prefix:MR
First Name:TEDDY
Middle Name:
Last Name:REEVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-7990
Mailing Address - Country:US
Mailing Address - Phone:731-641-4545
Mailing Address - Fax:731-641-4546
Practice Address - Street 1:2555 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-7990
Practice Address - Country:US
Practice Address - Phone:731-641-4545
Practice Address - Fax:731-641-4546
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)