Provider Demographics
NPI:1194042457
Name:REYNOLDS, ALEC (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEC
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PANGUITCH
Mailing Address - State:UT
Mailing Address - Zip Code:84759-7865
Mailing Address - Country:US
Mailing Address - Phone:435-676-8176
Mailing Address - Fax:435-676-2615
Practice Address - Street 1:601 E CENTER ST
Practice Address - Street 2:
Practice Address - City:PANGUITCH
Practice Address - State:UT
Practice Address - Zip Code:84759-7865
Practice Address - Country:US
Practice Address - Phone:435-676-8176
Practice Address - Fax:435-676-2615
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA684361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical