Healthcare Provider Details

I. General information

NPI: 1548841158
Provider Name (Legal Business Name): FALLON M. REYNOLDS ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2742 CENTRAL PKWY
MONTGOMERY AL
36106-3243
US

IV. Provider business mailing address

416 ROCK LEDGE CT
MONTGOMERY AL
36117-7682
US

V. Phone/Fax

Practice location:
  • Phone: 334-647-1009
  • Fax: 888-856-7677
Mailing address:
  • Phone: 334-782-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC3450A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: