Basic Information
| Provider Information | |||||||||
| NPI: | 1245309715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REEVES | ||||||||
| FirstName: | SHERRILL | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 STEWART RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481625304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342401760 | ||||||||
| FaxNumber: | 7342401780 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 STEWART RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481625304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342401760 | ||||||||
| FaxNumber: | 7342401780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 680146935 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 6801046935 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 8008971070 | 01 | MI | BCBS | OTHER | 80-0-89-7107-0 | 01 | MI | BCBS | OTHER |