Provider Demographics
NPI:1215029178
Name:REYNAUD, MARK RYAN (MA, LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:RYAN
Last Name:REYNAUD
Suffix:
Gender:M
Credentials:MA, LPC, LMFT
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Mailing Address - Street 1:4787 WAYWOOD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2465
Mailing Address - Country:US
Mailing Address - Phone:225-654-6321
Mailing Address - Fax:225-654-6321
Practice Address - Street 1:4787 WAYWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2465
Practice Address - Country:US
Practice Address - Phone:225-654-6321
Practice Address - Fax:225-654-6321
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2011-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA1734101YP2500X
LA99106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional