Provider Demographics
NPI:1225813462
Name:REYNOLDS, BROOKE ANNE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 W WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-9219
Mailing Address - Country:US
Mailing Address - Phone:615-689-8283
Mailing Address - Fax:
Practice Address - Street 1:1679 W WILSON BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-9219
Practice Address - Country:US
Practice Address - Phone:615-689-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician