Provider Demographics
NPI:1376262188
Name:LINDSEY REYNOSO, LCSW: MENTAL HEALTH COUNSELING & CONSULTING, PLLC
Entity Type:Organization
Organization Name:LINDSEY REYNOSO, LCSW: MENTAL HEALTH COUNSELING & CONSULTING, PLLC
Other - Org Name:LINDSEY L JENSEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW, CCTP, BSP
Authorized Official - Phone:480-442-5007
Mailing Address - Street 1:428 S GILBERT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2261
Mailing Address - Country:US
Mailing Address - Phone:480-442-5007
Mailing Address - Fax:
Practice Address - Street 1:230 E OHIO ST STE 4101152
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3265
Practice Address - Country:US
Practice Address - Phone:480-442-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871036640OtherINDIVIDUAL PROVIDER NPI