Healthcare Provider Details

I. General information

NPI: 1750824934
Provider Name (Legal Business Name): KEVIN JAMES REYNOLDS MS, LMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 PACIFIC AVE STE 1
AUDUBON IA
50025-1056
US

IV. Provider business mailing address

515 PACIFIC AVE STE 1
AUDUBON IA
50025-1056
US

V. Phone/Fax

Practice location:
  • Phone: 712-563-5285
  • Fax: 855-303-9139
Mailing address:
  • Phone: 712-563-5285
  • Fax: 855-303-9139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number095019
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: