Basic Information
| Provider Information | |||||||||
| NPI: | 1922076850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REEVES | ||||||||
| FirstName: | FERN | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2075 LINCOLN PARK DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472013778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123764800 | ||||||||
| FaxNumber: | 8123764897 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 N MARR RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472016660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123143400 | ||||||||
| FaxNumber: | 8123788367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 39000203A | IN | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 33000464A | IN | X | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.