Mary R Reavis, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3163 Issued in NC

Practice address

518 S Aspen St
Lincolnton, NC 28092-2735

Phone

(704) 530-0850

Fax

(704) 735-9810

NPI assigned

May 9, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Psyclinc

  • Community/Behavioral Health Agency
  • Lincolnton, NC
  • NPI 1235538901
  NPD (past) Authorized official
• Psyclinc

  • Clinical Psychologist
  • Lincolnton, NC
  • NPI 1356517536
  NPD (past) Authorized official
• Carolinas Counseling Solutions Inc.

  • Mental Health Counselor
  • Statesville, NC
  • NPI 1437388766
  NPD (past)
• Mental Health Provider Services LLC

  • Psychologist
  • Statesville, NC
  • NPI 1679708721
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453334400000",
    "number": "1659320265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 S ASPEN ST",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280922735",
            "telephone_number": "704-530-0850",
            "fax_number": "704-735-9810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 S ASPEN ST",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280922735",
            "telephone_number": "704-530-0850",
            "fax_number": "704-735-9810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAVIS",
        "first_name": "MARY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-09",
        "last_updated": "2016-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "3163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000865",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• R. Gary Hensley, D.M.D., P.a.
• Toma Radut, MD
• Christopher J Ramke, DMD
• Taylor Jane Ratliffe
• Ray L Burris DC PA
• Recovery Center of North Carolina, LLC
• Michael Jerome Reel, LPC
• Jason S Reese, P.T.
• John L Reese, CRNA
• Regional Orthopedics Hand and Sports Medicine Center

• Clinical Psychologist in Lincolnton, NC
• Providers in Lincolnton, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.