Healthcare Provider Details

I. General information

NPI: 1982936035
Provider Name (Legal Business Name): GLENDA PHILLIPS REYNOLDS ED. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2010
Last Update Date: 01/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RIDGE PARK DR
MONTGOMERY AL
36117-8032
US

IV. Provider business mailing address

207 WINTON BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

V. Phone/Fax

Practice location:
  • Phone: 334-538-0900
  • Fax:
Mailing address:
  • Phone: 334-538-0900
  • Fax: 334-356-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1613A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: