Healthcare Provider Details

I. General information

NPI: 1902180813
Provider Name (Legal Business Name): KELLEY LYNN REYNOLDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY ASBURRY LCSW

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 MAIN ST STE 218-158
WINDSOR CO
80550-7913
US

IV. Provider business mailing address

1540 MAIN ST STE 218-158
WINDSOR CO
80550-7913
US

V. Phone/Fax

Practice location:
  • Phone: 602-402-1711
  • Fax:
Mailing address:
  • Phone: 602-402-1711
  • Fax: 480-804-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9931140
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-15386
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: