Healthcare Provider Details

I. General information

NPI: 1558885368
Provider Name (Legal Business Name): JACQUELINE MARIE REYNOLDS MA, ATR-BC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S 9TH ST
PITTSBURGH PA
15203-1266
US

IV. Provider business mailing address

1647 MONONGAHELA AVE
PITTSBURGH PA
15218-2003
US

V. Phone/Fax

Practice location:
  • Phone: 412-697-0712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009740
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: