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General NPI Number Information
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NPI Number | 1215181219
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Entity Type | Individual
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Provider Name | GABRIELLE REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 3003 HUALAPAI MOUNTAIN RD LOT 8
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City | KINGMAN
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State | AZ
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Zip | 86401-5390
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Country | US
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Telephone | 520-748-7108
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Fax |
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Provider Business Mailing Address
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Address Line | 1161 N EL DORADO PL STE 103
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City | TUCSON
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State | AZ
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Zip | 85715-4607
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Country | US
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Telephone | 928-919-2927
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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 | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State | AZ
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