Healthcare Provider Details

I. General information

NPI: 1043402704
Provider Name (Legal Business Name): JAMES BRIAN REEVES M.A., L.P.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LOUISIANA BLVD NE STE C
ALBUQUERQUE NM
87110-1448
US

IV. Provider business mailing address

203 SILVER AVE SW UNIT 312
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-1686
  • Fax: 505-888-1683
Mailing address:
  • Phone: 575-313-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4369
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: