Provider Demographics
NPI:1528566684
Name:UNIVERSAL MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:UNIVERSAL MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVAR
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CSAC, MAC, CSOTI
Authorized Official - Phone:757-604-3426
Mailing Address - Street 1:714 J. CLYDE MORRIS BLVD. STE. 180
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601
Mailing Address - Country:US
Mailing Address - Phone:757-706-3309
Mailing Address - Fax:
Practice Address - Street 1:714 J. CLYDE MORRIS BLVD.
Practice Address - Street 2:SUITE 180
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1535
Practice Address - Country:US
Practice Address - Phone:757-706-3309
Practice Address - Fax:757-706-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health