Provider Demographics
NPI:1750824934
Name:REYNOLDS, KEVIN JAMES (MS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2063
Mailing Address - Country:US
Mailing Address - Phone:712-755-5056
Mailing Address - Fax:
Practice Address - Street 1:1303 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2063
Practice Address - Country:US
Practice Address - Phone:712-304-5994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health