Provider Demographics
NPI:1790679942
Name:REEVES, AUTUMN JADE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:JADE
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13258 COUNTRY WALK CT
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2366
Mailing Address - Country:US
Mailing Address - Phone:248-870-9466
Mailing Address - Fax:
Practice Address - Street 1:13258 COUNTRY WALK CT
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-2366
Practice Address - Country:US
Practice Address - Phone:248-870-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician