Provider Demographics
NPI:1619071651
Name:REEVAS, KIMBERLY LYNN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:REEVAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:REEVAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1810 BRIAM DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1151
Mailing Address - Country:US
Mailing Address - Phone:317-679-2895
Mailing Address - Fax:
Practice Address - Street 1:119 BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2477
Practice Address - Country:US
Practice Address - Phone:317-679-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490101181041C0700X
IN34004617A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical