Provider Demographics
NPI:1770193898
Name:REYNOLDS, KARA DALENE (MA, LBS, NCC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:DALENE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA, LBS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W WALNUT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3303
Mailing Address - Country:US
Mailing Address - Phone:717-419-8186
Mailing Address - Fax:
Practice Address - Street 1:419 W WALNUT ST APT 2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3303
Practice Address - Country:US
Practice Address - Phone:717-419-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003021103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty