Provider Demographics
NPI:1437359387
Name:REYNOLDS, EMILY DAWN (QMHP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DAWN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SW KINKADE ROAD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OR
Mailing Address - Zip Code:97818
Mailing Address - Country:US
Mailing Address - Phone:541-481-2911
Mailing Address - Fax:541-481-2006
Practice Address - Street 1:104 SW KINKADE ROAD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OR
Practice Address - Zip Code:97818
Practice Address - Country:US
Practice Address - Phone:541-481-2911
Practice Address - Fax:541-481-2006
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator