Provider Demographics
NPI:1629745237
Name:REYNOLDS, DAISY A (LPC-A, LCDC)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPC-A, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 HAMBRICK RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-1744
Mailing Address - Country:US
Mailing Address - Phone:214-818-1360
Mailing Address - Fax:
Practice Address - Street 1:4600 GREENVILLE AVE STE 252
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5037
Practice Address - Country:US
Practice Address - Phone:214-618-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional