Provider Demographics
NPI:1225104037
Name:REYNOLDS, PHYLLIS JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JEAN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:PHYLLIS
Other - Middle Name:J
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2112 CANNON ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-1545
Mailing Address - Country:US
Mailing Address - Phone:406-422-0253
Mailing Address - Fax:
Practice Address - Street 1:2112 CANNON ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-422-0253
Practice Address - Fax:307-682-8602
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY777101YP2500X
MT434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional