Provider Demographics
NPI:1528384104
Name:REYNOLDS, SHENANDOAH DAWN (LMFT)
Entity Type:Individual
Prefix:
First Name:SHENANDOAH
Middle Name:DAWN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHENANDOAH
Other - Middle Name:DAWN
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:3175 NE ALOCLEK DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7135
Mailing Address - Country:US
Mailing Address - Phone:503-858-9642
Mailing Address - Fax:
Practice Address - Street 1:2960 CAMINO DIABLO
Practice Address - Street 2:210
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3988
Practice Address - Country:US
Practice Address - Phone:925-938-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53089OtherMFT LICENSE