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General NPI Number Information
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NPI Number | 1629229158
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Entity Type | Individual
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Provider Name | KELLY M REYNERSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 1929 23RD AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-3108
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Country | US
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Telephone | 601-482-7377
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Fax | 601-482-7332
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Provider Business Mailing Address
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Address Line | 1929 23RD AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-3108
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Country | US
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Telephone | 601-482-7377
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Fax | 601-482-7332
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 9796
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | M7695
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License Number State | MS
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