Provider Demographics
NPI:1447954078
Name:REEVES, LAURA OLITA (LCDC-I)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:OLITA
Last Name:REEVES
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:OLITA
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC-I
Mailing Address - Street 1:20351 HIGHWAY 6 STE B
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3882
Mailing Address - Country:US
Mailing Address - Phone:979-233-1584
Mailing Address - Fax:
Practice Address - Street 1:20351 HIGHWAY 6 STE B
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3882
Practice Address - Country:US
Practice Address - Phone:979-233-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)