Provider Demographics
NPI:1508478595
Name:AMY REYNELLI COUNSELING PLLC
Entity Type:Organization
Organization Name:AMY REYNELLI COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, MLADC
Authorized Official - Phone:603-361-3373
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:STODDARD
Mailing Address - State:NH
Mailing Address - Zip Code:03464-0264
Mailing Address - Country:US
Mailing Address - Phone:603-361-3373
Mailing Address - Fax:
Practice Address - Street 1:272 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4122
Practice Address - Country:US
Practice Address - Phone:603-361-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1114235538Medicaid