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General NPI Number Information
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NPI Number | 1639782360
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Entity Type | Individual
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Provider Name | KIMBERLY REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 134 ANSEL HALLET RD STE 3
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City | WEST YARMOUTH
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State | MA
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Zip | 02673-2582
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Country | US
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Telephone | 774-470-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 76 JOHN MAKI RD
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City | WEST BARNSTABLE
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State | MA
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Zip | 02668-1131
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Country | US
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Telephone | 949-887-7205
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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