=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376262188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINDSEY REYNOSO, LCSW: MENTAL HEALTH COUNSELING & CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2022
-----------------------------------------------------
Last Update Date | 03/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 E OHIO ST STE 4101152
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-442-5007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 428 S GILBERT RD STE 105
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85296-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-442-5007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MRS. LINDSEY L. REYNOSO
-----------------------------------------------------
Credential | LCSW, MSW, CCTP, BSP
-----------------------------------------------------
Telephone | 480-442-5007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------