Provider Demographics
NPI:1154906584
Name:BLUE COVE PSYCHOTHERAPY SERVICES
Entity type:Organization
Organization Name:BLUE COVE PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:REYNOLDS-NEU
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:205-420-1742
Mailing Address - Street 1:3686 SIMPSON POINT RD
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:AL
Mailing Address - Zip Code:35747-7913
Mailing Address - Country:US
Mailing Address - Phone:205-420-1742
Mailing Address - Fax:
Practice Address - Street 1:917 WILLOWBROOK DR SE # F3
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3263
Practice Address - Country:US
Practice Address - Phone:205-420-1742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty