Provider Demographics
NPI:1275309973
Name:REEVES, SHELBY LYNN (LPC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:REEVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PIATONIA RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:MS
Mailing Address - Zip Code:39455-7517
Mailing Address - Country:US
Mailing Address - Phone:601-549-8202
Mailing Address - Fax:
Practice Address - Street 1:2112 BIENVILLE BLVD STE K
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3067
Practice Address - Country:US
Practice Address - Phone:228-819-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3074101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty