Provider Demographics
NPI:1689317158
Name:REYNOLDS, TAYLOR RENAE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E YANT FLAT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1953
Mailing Address - Country:US
Mailing Address - Phone:435-632-0607
Mailing Address - Fax:
Practice Address - Street 1:321 N MALL DR STE E102
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7305
Practice Address - Country:US
Practice Address - Phone:435-631-9964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11347528-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical