MEDICARE: REYNOLDS & ASSOCIATES COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1457028698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYNOLDS & ASSOCIATES COUNSELING LLC

Provider Business Mailing Address
First Line	:	7212 N SHADELAND AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-5901
Country	:	US
Telephone Number	:	317-800-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	7212 N SHADELAND AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-5901
Country	:	US
Telephone Number	:	317-800-7707
Fax Number	:

Authorized Official
Title or Position	:	LCSW/OWNER
Name	:	CYNTHIA REYNOLDS
Credential	:
Telephone Number	:	317-800-7707

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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