Provider Demographics
NPI:1982566808
Name:REEVES, PAMELA JEAN (MSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
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 1:2215 BLUE GUM AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-1052
Mailing Address - Country:US
Mailing Address - Phone:209-525-4580
Mailing Address - Fax:
Practice Address - Street 1:2215 BLUE GUM AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-1052
Practice Address - Country:US
Practice Address - Phone:209-525-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW106894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health