Provider Demographics
NPI:1831624824
Name:REEVES, JONATHAN (PHD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:REEVES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 4TH AVE UNIT 2183
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083-0199
Mailing Address - Country:US
Mailing Address - Phone:206-504-3261
Mailing Address - Fax:
Practice Address - Street 1:721 4TH AVE UNIT 2183
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98083-0199
Practice Address - Country:US
Practice Address - Phone:206-504-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61003047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical