MEDICARE: MR. MICHAEL HENRY REYNOLDS II

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	6103	OK

General Provider Information

NPI Number	:	1881913150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL HENRY REYNOLDS II

Provider Business Mailing Address
First Line	:	32790 STATE HIGHWAY 99 S
Second Line	:
City	:	STONEWALL
State	:	OK
Zip	:	74871-6128
Country	:	US
Telephone Number	:	580-272-3855
Fax Number	:

Provider Business Practice Location Address
First Line	:	32790 STATE HIGHWAY 99 S
Second Line	:
City	:	STONEWALL
State	:	OK
Zip	:	74871-6128
Country	:	US
Telephone Number	:	580-272-3855
Fax Number	:

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

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	12/15/2023

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