MEDICARE: ANISA 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
1	101YM0800X	Mental Health Counselor		MO

General Provider Information

NPI Number	:	1841096781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANISA REYNOLDS

Provider Business Mailing Address
First Line	:	8455 GLEN ECHO DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3017 LACLEDE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2135
Country	:	US
Telephone Number	:	314-340-5089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2025
Last Update Date	:	02/21/2025

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Directions to “ ANISA REYNOLDS ” Practice Location

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