Provider Demographics
NPI:1538202973
Name:REAVES, LARRIANN (BA OMHA)
Entity type:Individual
Prefix:
First Name:LARRIANN
Middle Name:
Last Name:REAVES
Suffix:
Gender:F
Credentials:BA OMHA
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:REAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:92745 FIR RD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-8607
Mailing Address - Country:US
Mailing Address - Phone:503-791-3961
Mailing Address - Fax:
Practice Address - Street 1:92745 FIR RD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-8607
Practice Address - Country:US
Practice Address - Phone:503-791-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor