Provider Demographics
NPI:1568708626
Name:REYNOLDS, CAL (LPC)
Entity Type:Individual
Prefix:
First Name:CAL
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 N BALTIMORE AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5458
Mailing Address - Country:US
Mailing Address - Phone:971-350-9329
Mailing Address - Fax:
Practice Address - Street 1:6635 N BALTIMORE AVE STE 275
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5458
Practice Address - Country:US
Practice Address - Phone:971-350-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No372600000XNursing Service Related ProvidersAdult Companion