Provider Demographics
NPI:1346726304
Name:REYNOLDS, JAMES DAVID (LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 WOODVALE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-2438
Mailing Address - Country:US
Mailing Address - Phone:432-528-2111
Mailing Address - Fax:
Practice Address - Street 1:16160 MIDWAY RD STE 218
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4207
Practice Address - Country:US
Practice Address - Phone:469-680-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional