Healthcare Provider Details

I. General information

NPI: 1871417329
Provider Name (Legal Business Name): DAVID G REYNOSO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654 W LIVINGSTON ESTATES CT
YUMA AZ
85365-7984
US

IV. Provider business mailing address

3654 W LIVINGSTON ESTATES CT
YUMA AZ
85365-7984
US

V. Phone/Fax

Practice location:
  • Phone: 928-366-0867
  • Fax:
Mailing address:
  • Phone: 928-366-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-22784
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: