Basic Information
| Provider Information | |||||||||
| NPI: | 1962739565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REEVE | ||||||||
| FirstName: | KIRSTI | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3822 ELMHURST AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480731823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485499125 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1370 N OAKLAND BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483274525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486668870 | ||||||||
| FaxNumber: | 2486665023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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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 | 101Y00000X | 6401011612 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.