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General NPI Number Information
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NPI Number | 1013420751
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Entity Type | Individual
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Provider Name | MANIJEH REYNOLDS LPCC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 7614 PAULS VIEW PL
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City | LOUISVILLE
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State | KY
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Zip | 40228-1357
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Country | US
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Telephone | 316-390-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 9100 FERN CREEK RD UNIT 91796
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City | LOUISVILLE
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State | KY
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Zip | 40291-7035
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Country | US
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Telephone | 316-390-0434
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Fax | 502-830-9800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 03344
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3056
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 279091
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License Number State | KY
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