1730254525 NPI number — MR. JAMES R REAVES, JR. LCSW,PIP

Table of content: MR. JAMES R REAVES, JR. LCSW,PIP (NPI 1730254525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730254525 NPI number — MR. JAMES R REAVES, JR. LCSW,PIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REAVES, JR.
Provider First Name:
JAMES
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW,PIP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730254525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 SABINA DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36265-2654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-283-4816
Provider Business Mailing Address Fax Number:
256-835-7927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1204 SABINA DR SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36265-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-283-4816
Provider Business Practice Location Address Fax Number:
256-835-7927
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0062C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44002 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 089512 . This is a "VALUE OPTIONS PROVIDER NO" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com