Provider Demographics
NPI:1306614318
Name:SHELLY REAVES COUNSELING SERVICES
Entity type:Organization
Organization Name:SHELLY REAVES COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADAC
Authorized Official - Phone:479-422-4657
Mailing Address - Street 1:1732 SE MOBERLY LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9239
Mailing Address - Country:US
Mailing Address - Phone:479-422-4657
Mailing Address - Fax:
Practice Address - Street 1:1732 SE MOBERLY LN
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-9239
Practice Address - Country:US
Practice Address - Phone:479-422-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty