Provider Demographics
NPI:1528441631
Name:REEVES, LISA CATHERINE (LCSW, MA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CATHERINE
Last Name:REEVES
Suffix:
Gender:F
Credentials:LCSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 BURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-1849
Mailing Address - Country:US
Mailing Address - Phone:208-814-9100
Mailing Address - Fax:
Practice Address - Street 1:980 BURLEY AVE
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-1849
Practice Address - Country:US
Practice Address - Phone:208-814-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-364241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical