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General NPI Number Information
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NPI Number | 1386151421
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Entity Type | Individual
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Provider Name | MRS. MITZI ELLA REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 102 WINSTON WAY STE 1
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-4953
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Country | US
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Telephone | 270-849-2157
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Fax | 888-975-1981
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Provider Business Mailing Address
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Address Line | 790 MCELROY PIKE
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City | LEBANON
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State | KY
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Zip | 40033-9368
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 104279
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License Number State | KY
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