Provider Demographics
NPI:1679608509
Name:REYNOLDS, SHILOH
Entity Type:Individual
Prefix:
First Name:SHILOH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHILOH
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:875 WAIMANU ST STE 612
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5267
Mailing Address - Country:US
Mailing Address - Phone:808-791-6713
Mailing Address - Fax:808-791-6081
Practice Address - Street 1:875 WAIMANU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5248
Practice Address - Country:US
Practice Address - Phone:808-533-3936
Practice Address - Fax:808-791-6198
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60154399101YM0800X
HICG60154399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health