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General NPI Number Information
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NPI Number | 1639065105
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Entity Type | Individual
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Provider Name | MYESHA REYNOLDS LMFT-A
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Gender | Female
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 4179 S RIVERBOAT RD STE 240
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City | MURRAY
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State | UT
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Zip | 84123-2986
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Country | US
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Telephone | 919-971-8744
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Fax |
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Provider Business Mailing Address
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Address Line | 4179 S RIVERBOAT RD STE 240
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City | MURRAY
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State | UT
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Zip | 84123-2986
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Country | US
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Telephone | 919-971-8744
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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 | 14222782-3904
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License Number State | UT
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