Provider Demographics
NPI:1114570363
Name:REEVES, ANGELA M (MASTER SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:REEVES
Suffix:
Gender:F
Credentials:MASTER SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 RIVERCREST DR APT 201
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3092
Mailing Address - Country:US
Mailing Address - Phone:082-308-9347
Mailing Address - Fax:
Practice Address - Street 1:451 EASTLAND DR STE 5
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7454
Practice Address - Country:US
Practice Address - Phone:208-308-9347
Practice Address - Fax:208-556-7546
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID103K00000X
ID9361579104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1114570363Medicaid
ID1114570363Medicaid