Provider Demographics
NPI:1750687125
Name:REYNOLDS, KAILAN C (N/A)
Entity Type:Individual
Prefix:
First Name:KAILAN
Middle Name:C
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 GOOD EARTH CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7120
Mailing Address - Country:US
Mailing Address - Phone:423-605-2673
Mailing Address - Fax:
Practice Address - Street 1:709 DAVIDSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3607
Practice Address - Country:US
Practice Address - Phone:931-393-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health