Provider Demographics
NPI:1952603128
Name:REEVE, ANITA (BA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:REEVE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:COLEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96107-9510
Mailing Address - Country:US
Mailing Address - Phone:530-495-2160
Mailing Address - Fax:
Practice Address - Street 1:452 OLD MAMMOTH ROAD, 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-2619
Practice Address - Country:US
Practice Address - Phone:760-924-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health