Healthcare Provider Details

I. General information

NPI: 1447968003
Provider Name (Legal Business Name): CHANELLE REEVES LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9329 TELEGRAPH RD
REDFORD MI
48239-1260
US

IV. Provider business mailing address

24425 W. 9 MILE ROAD 2445 W. 9 MILE ROAD
SOUTHFIELD MI
48033-4222
US

V. Phone/Fax

Practice location:
  • Phone: 313-937-9500
  • Fax: 313-937-9504
Mailing address:
  • Phone: 248-876-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451022465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: