Provider Demographics
NPI:1578877809
Name:REYNOLDS, KIM DEE (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:DEE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BELT LINE RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3299
Mailing Address - Country:US
Mailing Address - Phone:214-274-8524
Mailing Address - Fax:
Practice Address - Street 1:1111 BELT LINE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3299
Practice Address - Country:US
Practice Address - Phone:214-274-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201184106H00000X
TX65905101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional