Provider Demographics
NPI:1033266424
Name:REYNOLDS, KRISTIE LYNN (MS, MA, LPC-S)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2707
Mailing Address - Country:US
Mailing Address - Phone:361-688-6393
Mailing Address - Fax:361-991-7421
Practice Address - Street 1:426 MONTCLAIR DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2707
Practice Address - Country:US
Practice Address - Phone:361-688-6393
Practice Address - Fax:361-991-7421
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16252790Medicaid