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General NPI Number Information
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NPI Number | 1154849784
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Entity Type | Individual
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Provider Name | ANDREA REYNOLDS LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/04/2017
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 9917 219TH ST SE
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City | SNOHOMISH
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State | WA
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Zip | 98296-4939
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Country | US
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Telephone | 253-642-7766
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Fax |
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Provider Business Mailing Address
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Address Line | 2267 W WYSTERIA DR
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City | MAPLETON
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State | UT
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Zip | 84664-4450
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF61299730
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License Number State | WA
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