Doctor Name: | WENDY B. REYNOLDS |
NPI Number: | 1053321091 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BSW |
License Number: | |
Business Practice Address: | 126 N Bell Ave Shawnee, OK - 748016902 |
Business Phone Number: | 4052757100 |
Business Fax Number: | 4052757105 |
Mailing Address: | 19806 Malone Rd, TECUMSEH |
State: | OK |
Postal Code: | 748737212 |
Phone Number: | 4052147869 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |