Provider Demographics
NPI:1801965215
Name:REEVES, ELIZABETH R (MS,LPC,LMFT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:R
Last Name:REEVES
Suffix:
Gender:F
Credentials:MS,LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FONTAINE PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5228
Mailing Address - Country:US
Mailing Address - Phone:601-956-1992
Mailing Address - Fax:601-956-9935
Practice Address - Street 1:405 FONTAINE PL
Practice Address - Street 2:SUITE 101
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5228
Practice Address - Country:US
Practice Address - Phone:601-956-1992
Practice Address - Fax:601-956-9935
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0609OtherLPC LICENSE
MST0093OtherLMFT LICENSE