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General NPI Number Information
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NPI Number | 1154629624
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Entity Type | Individual
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Provider Name | RAYMOND KYLE REEVES MA, LPC, CCDP-D
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Gender | Male
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 5536 HIGHWAY 32
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City | FARMINGTON
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State | MO
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Zip | 63640-7357
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Country | US
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Telephone | 573-756-5749
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 459
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City | FARMINGTON
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State | MO
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Zip | 63640-0459
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6025
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2011009541
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License Number State | MO
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