Provider Demographics
NPI:1114152824
Name:REYNOLDS, CARRIE M (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 STANDISH ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6421
Mailing Address - Country:US
Mailing Address - Phone:847-742-5717
Mailing Address - Fax:
Practice Address - Street 1:240 STANDISH ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-6421
Practice Address - Country:US
Practice Address - Phone:847-742-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional