Provider Demographics
NPI:1639857402
Name:REYNOLDS, TONY JOQWEARVEON (BSW)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:JOQWEARVEON
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 PERUGIA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3499
Mailing Address - Country:US
Mailing Address - Phone:702-355-5659
Mailing Address - Fax:
Practice Address - Street 1:6600 W CHARLESTON BLVD STE 111
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1067
Practice Address - Country:US
Practice Address - Phone:702-763-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker