Provider Demographics
NPI:1407074156
Name:REYNOLDS, DENISE J (MFT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:J
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-0695
Mailing Address - Country:US
Mailing Address - Phone:925-283-1719
Mailing Address - Fax:925-552-0576
Practice Address - Street 1:3702 MT DIABLO BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3686
Practice Address - Country:US
Practice Address - Phone:925-283-1719
Practice Address - Fax:925-552-0576
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25116106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist