Healthcare Provider Details

I. General information

NPI: 1447495825
Provider Name (Legal Business Name): JANET H WILKS REYNOLDS LMHC IN WA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET H WILKS REYNOLDS LPC IN OR

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 08/27/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 BROWN RD
FERNDALE WA
98248-5406
US

IV. Provider business mailing address

3403 BROWN RD
FERNDALE WA
98248-5406
US

V. Phone/Fax

Practice location:
  • Phone: 360-393-7931
  • Fax: 503-575-2761
Mailing address:
  • Phone: 360-393-7931
  • Fax: 503-575-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00008011
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2240
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: