| Doctor Name: | MR. MARK RYAN REYNAUD |
| NPI Number: | 1215029178 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, LPC, LMFT |
| License Number: | 1734 |
| Business Practice Address: | 4787 Waywood Dr Suite C Zachary, LA - 707912465 |
| Business Phone Number: | 2256546321 |
| Business Fax Number: | 2256546321 |
| Mailing Address: | 4787 Waywood Dr, Suite C ZACHARY |
| State: | LA |
| Postal Code: | 707912465 |
| Phone Number: | 2256546321 |
| Fax Number: | 2256546321 |
| NPI Enumeration Date: | 09/29/2006 |
| NPI Last Update Date: | 06/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1734 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |