Doctor Name: | DR. RAE MARIE MCREYNOLDS |
NPI Number: | 1053452342 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L. P. C. |
License Number: | LPC-607 |
Business Practice Address: | 23 E Brundage St Sheridan, WY - 828016302 |
Business Phone Number: | 3076749697 |
Business Fax Number: | |
Mailing Address: | 23 E Brundage St, SHERIDAN |
State: | WY |
Postal Code: | 828016302 |
Phone Number: | 3076749697 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPC-607 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |