Provider Demographics
NPI:1326727157
Name:REYNOLDS, REBECCA (CADCR)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CADCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3337
Mailing Address - Country:US
Mailing Address - Phone:541-653-8284
Mailing Address - Fax:
Practice Address - Street 1:1485 MARKET ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3337
Practice Address - Country:US
Practice Address - Phone:541-653-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-23-2602101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT-23-2602OtherMHACBO