Doctor Name: | RUSS REYNOLDS |
NPI Number: | 1114361037 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | P1422 |
Business Practice Address: | 301 Bear Creek Rd. Oak Ridge, TN - 378312820 |
Business Phone Number: | 8655743434 |
Business Fax Number: | |
Mailing Address: | 301 Bear Creek Rd., P.o. Box 2009 OAK RIDGE |
State: | TN |
Postal Code: | 378312820 |
Phone Number: | 8655743434 |
Fax Number: | |
NPI Enumeration Date: | 04/22/2013 |
NPI Last Update Date: | 04/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | P1422 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |