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NPI Code Detail

MEDICARE: STEVEN REYNOLDS

MEDICARE: STEVEN REYNOLDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1457977381
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN REYNOLDS
Provider Business Mailing Address
First Line : 980 VIOLET AVE SE
Second Line :
City : ATLANTA
State : GA
Zip : 30315-1825
Country : US
Telephone Number : 702-234-4677
Fax Number :
Provider Business Practice Location Address
First Line : 1030 FAYETTEVILLE RD SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-2921
Country : US
Telephone Number : 404-486-9034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2020
Last Update Date : 06/16/2020

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