Provider Demographics
NPI:1558492694
Name:REYNOLDS, LORI T (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:T
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 BRECKENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:CA
Mailing Address - Zip Code:95321-9507
Mailing Address - Country:US
Mailing Address - Phone:310-383-4953
Mailing Address - Fax:
Practice Address - Street 1:12015 BRECKENRIDGE RD
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:CA
Practice Address - Zip Code:95321-9507
Practice Address - Country:US
Practice Address - Phone:310-383-4953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC44079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist