Provider Demographics
NPI:1447968003
Name:REEVES, CHANELLE (LLPC)
Entity type:Individual
Prefix:MRS
First Name:CHANELLE
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24425 W. 9 MILE ROAD
Mailing Address - Street 2:2445 W. 9 MILE ROAD
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4222
Mailing Address - Country:US
Mailing Address - Phone:248-876-0175
Mailing Address - Fax:
Practice Address - Street 1:24225 W. MILE ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4222
Practice Address - Country:US
Practice Address - Phone:248-876-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty