Healthcare Provider Details

I. General information

NPI: 1164092664
Provider Name (Legal Business Name): GINA LYNN REID LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 CLARK RD SPC 4
PARADISE CA
95969-5159
US

IV. Provider business mailing address

5510 CLARK RD SPC 4
PARADISE CA
95969-5159
US

V. Phone/Fax

Practice location:
  • Phone: 530-591-0404
  • Fax:
Mailing address:
  • Phone: 530-591-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3652
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: