Provider Demographics
NPI:1487785614
Name:SEGISMUNDO REEVES, MICHELLE LYN (MA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYN
Last Name:SEGISMUNDO REEVES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYN
Other - Last Name:SEGISMUNDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 MARVIN RD NE STE 307
Mailing Address - Street 2:#265
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 39TH AVE SW STE 204
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3805
Practice Address - Country:US
Practice Address - Phone:206-208-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health