MEDICARE: CAL REYNOLDS LPC, LPCC

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	101YP2500X	Professional Counselor
2	372600000X	Adult Companion

General Provider Information

NPI Number	:	1568708626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAL REYNOLDS LPC, LPCC

Provider Business Mailing Address
First Line	:	6635 N BALTIMORE AVE STE 275
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-5458
Country	:	US
Telephone Number	:	971-350-9329
Fax Number	:

Provider Business Practice Location Address
First Line	:	6635 N BALTIMORE AVE STE 275
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-5458
Country	:	US
Telephone Number	:	971-350-9329
Fax Number	:

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

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	02/28/2025

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