Provider Demographics
NPI:1952847683
Name:REEVES, SHELLI
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5672 NW MCGEE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STRINGTOWN
Mailing Address - State:OK
Mailing Address - Zip Code:74569-2103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5672 NW MCGEE CREEK RD
Practice Address - Street 2:
Practice Address - City:STRINGTOWN
Practice Address - State:OK
Practice Address - Zip Code:74569-2103
Practice Address - Country:US
Practice Address - Phone:918-527-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK10543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator