Healthcare Provider Details

I. General information

NPI: 1902717663
Provider Name (Legal Business Name): MILES REEVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 W JIMMIE LEEDS RD
GALLOWAY NJ
08205-9411
US

IV. Provider business mailing address

327 S NEW RD
ABSECON NJ
08201-2513
US

V. Phone/Fax

Practice location:
  • Phone: 609-233-3867
  • Fax:
Mailing address:
  • Phone: 609-233-3867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00989100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: