Provider Demographics
NPI:1699055871
Name:REEVES, TERESA (MSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 NW 220TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-9167
Mailing Address - Country:US
Mailing Address - Phone:405-740-0253
Mailing Address - Fax:
Practice Address - Street 1:15310 N MAY AVE # 201
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-938-1444
Practice Address - Fax:405-938-1445
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1699055871Medicaid