MEDICARE: DAPHNE MICHELLE REYNOLDS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	17275	TX

General Provider Information

NPI Number	:	1821794397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAPHNE MICHELLE REYNOLDS LCDC

Provider Business Mailing Address
First Line	:	1050 N WESTMORELAND RD STE 330
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-2458
Country	:	US
Telephone Number	:	972-946-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 N WESTMORELAND RD STE 330
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-2458
Country	:	US
Telephone Number	:	214-715-4588
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	06/04/2026

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