Provider Demographics
NPI:1639247661
Name:REYNOLDS, KARRIE (MS, LMHP, CPC, NCC)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, LMHP, CPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11207 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2605
Mailing Address - Country:US
Mailing Address - Phone:402-964-2404
Mailing Address - Fax:
Practice Address - Street 1:11207 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2605
Practice Address - Country:US
Practice Address - Phone:402-964-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1559101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84782OtherBLUE CROSS BLUE SHIELD