Provider Demographics
NPI:1003830415
Name:REYNTJENS, KATHLEEN O'MALLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:O'MALLEY
Last Name:REYNTJENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARGARET
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 32747
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-2747
Mailing Address - Country:US
Mailing Address - Phone:505-603-5052
Mailing Address - Fax:505-982-9767
Practice Address - Street 1:110 DELGADO ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2781
Practice Address - Country:US
Practice Address - Phone:505-820-0963
Practice Address - Fax:505-982-9767
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0974103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling