Provider Demographics
NPI:1124011721
Name:REYNOLDS, RICHARD STEVEN (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEVEN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 OLD ORRVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6931
Mailing Address - Country:US
Mailing Address - Phone:334-877-3322
Mailing Address - Fax:334-877-3322
Practice Address - Street 1:1306 OLD ORRVILLE RD
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6931
Practice Address - Country:US
Practice Address - Phone:334-877-3322
Practice Address - Fax:334-877-3322
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL113524Medicaid
AL51599712OtherBLUE CROSS
S18861Medicare UPIN
AL102I683343Medicare PIN