MEDICARE: DAISY A REYNOLDS LPC-A, LCDC

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	86735	TX

General Provider Information

NPI Number	:	1629745237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY A REYNOLDS LPC-A, LCDC

Provider Business Mailing Address
First Line	:	451 HAMBRICK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-1744
Country	:	US
Telephone Number	:	214-818-1360
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 GREENVILLE AVE STE 252
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5037
Country	:	US
Telephone Number	:	214-618-8402
Fax Number	:

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	04/02/2023

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Directions to “ DAISY A REYNOLDS LPC-A, LCDC” Practice Location

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