Healthcare Provider Details

I. General information

NPI: 1205859824
Provider Name (Legal Business Name): MARY KATHRYN REEVES LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 TAYLOR RD
OWEGO NY
13827-1274
US

IV. Provider business mailing address

1277 TAYLOR RD
OWEGO NY
13827-1274
US

V. Phone/Fax

Practice location:
  • Phone: 607-744-1100
  • Fax:
Mailing address:
  • Phone: 607-744-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000786
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001150
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003804
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000786
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: