Provider Demographics
NPI:1740400159
Name:REYNOLDS, TODD E (MSW, LAT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:E
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MSW, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3159
Mailing Address - Country:US
Mailing Address - Phone:307-634-9653
Mailing Address - Fax:307-638-8256
Practice Address - Street 1:2526 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3159
Practice Address - Country:US
Practice Address - Phone:307-634-9653
Practice Address - Fax:307-638-8256
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPAT-014101YA0400X
WY307101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)