Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-18511 | AZ |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1144523267 |
---|---|
Provider Name | Ms. Bianca Reaves |
First Address | Tempe, AZ 85281-2198 |
Second Address | Las Vegas, NV 89102-1682 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2010 |
Last Update Date | 14/10/2021 |