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General NPI Number Information
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NPI Number | 1932893526
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Entity Type | Individual
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Provider Name | JOSEPH WILLIAM REYNOLDS IV LMSW
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Gender | Male
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 704 HISTORIC ROUTE 66 W SUITE 101
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City | WAYNESVILLE
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State | MO
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Zip | 65583
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Country | US
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Telephone | 573-433-4846
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Fax |
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Provider Business Mailing Address
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Address Line | 166 BOSA DR
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City | SAINT ROBERT
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State | MO
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Zip | 65584-4643
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Country | US
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Telephone | 573-528-3510
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2023018578
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License Number State | MO
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