Healthcare Provider Details

I. General information

NPI: 1316634728
Provider Name (Legal Business Name): CHASE GASTON REYNOLDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date: 03/19/2026
Reactivation Date: 03/31/2026

III. Provider practice location address

3020 S 7TH ST
KANSAS CITY KS
66103-2602
US

IV. Provider business mailing address

3965 W 83RD ST
PRAIRIE VILLAGE KS
66208-5308
US

V. Phone/Fax

Practice location:
  • Phone: 913-258-5322
  • Fax:
Mailing address:
  • Phone: 913-258-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: