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1477809119

NPI Code Detail

MEDICARE: DR. SHAUNA MOORE REYNOLDS ED.D., NCC,LPC, LCPC

MEDICARE: DR. SHAUNA MOORE REYNOLDS ED.D., NCC,LPC, LCPC

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	101YM0800X	Mental Health Counselor	PCR14291	DC
2	101YP2500X	Professional Counselor	PRC14291	DC
3	101Y00000X	Counselor	PCR14291	DC
4	101Y00000X	Counselor	LC4866	MD
5	101YM0800X	Mental Health Counselor	LC4866	MD
6	106H00000X	Marriage & Family Therapist	LC4866	MD
7	106H00000X	Marriage & Family Therapist	PCR14291	DC
8	101YP2500X	Professional Counselor	LC4866	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477809119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUNA MOORE REYNOLDS ED.D., NCC,LPC, LCPC

Provider Business Mailing Address
First Line	:	PO BOX 275
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-0275
Country	:	US
Telephone Number	:	240-389-1487
Fax Number	:	240-389-1463

Provider Business Practice Location Address
First Line	:	11785 BELTSVILLE DR STE 120
Second Line	:
City	:	CALVERTON
State	:	MD
Zip	:	20705-3121
Country	:	US
Telephone Number	:	240-389-1487
Fax Number	:	240-389-1463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	02/07/2024

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Directions to “ DR. SHAUNA MOORE REYNOLDS ED.D., NCC,LPC, LCPC” Practice Location

Language	Start Address	Practice Location

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