Provider Demographics
NPI:1477813921
Name:REYNOLDS, BRET LEON
Entity Type:Individual
Prefix:MR
First Name:BRET
Middle Name:LEON
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2140
Mailing Address - Country:US
Mailing Address - Phone:805-710-7341
Mailing Address - Fax:
Practice Address - Street 1:245 INGER DR
Practice Address - Street 2:SUITE 103/B
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8669
Practice Address - Country:US
Practice Address - Phone:805-357-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)