Provider Demographics
NPI:1699529701
Name:REAVES, SHANNON S
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:S
Last Name:REAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:487B SKIPPERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-7103
Mailing Address - Country:US
Mailing Address - Phone:334-672-0598
Mailing Address - Fax:
Practice Address - Street 1:487B SKIPPERVILLE RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-7103
Practice Address - Country:US
Practice Address - Phone:334-672-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician