Provider Demographics
NPI:1770930042
Name:REEVES, LUCRESHA (MS)
Entity type:Individual
Prefix:
First Name:LUCRESHA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 SANTA CLARA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951
Mailing Address - Country:US
Mailing Address - Phone:772-216-5062
Mailing Address - Fax:
Practice Address - Street 1:6804 SANTA CLARA BLVD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-1293
Practice Address - Country:US
Practice Address - Phone:772-216-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health