Provider Demographics
NPI:1689756579
Name:REYNISH, ALEX D (PSYD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:D
Last Name:REYNISH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2600
Mailing Address - Country:US
Mailing Address - Phone:847-528-0619
Mailing Address - Fax:
Practice Address - Street 1:1028 HOLLY LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2600
Practice Address - Country:US
Practice Address - Phone:847-528-0619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004821101Y00000X
IL071-007187103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL359600Medicare ID - Type Unspecified