Provider Demographics
NPI:1457712432
Name:REEVES, ANGEL (LMFT, IMH-E)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:LMFT, IMH-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2060
Mailing Address - Country:US
Mailing Address - Phone:541-337-1483
Mailing Address - Fax:
Practice Address - Street 1:210 S 5TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2105
Practice Address - Country:US
Practice Address - Phone:541-337-1483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1702106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist