Healthcare Provider Details

I. General information

NPI: 1144523267
Provider Name (Legal Business Name): MS. BIANCA REAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E WASHINGTON ST STE 300
PHOENIX AZ
85034-1908
US

IV. Provider business mailing address

1001 E PLAYA DEL NORTE DR UNIT 4134
TEMPE AZ
85281-2198
US

V. Phone/Fax

Practice location:
  • Phone: 702-595-1587
  • Fax: 602-532-7209
Mailing address:
  • Phone: 702-595-1587
  • Fax: 602-532-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-18511
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: