Provider Demographics
NPI:1821195918
Name:REYNOLDS, LUKE F (LMSW)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:F
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3720
Mailing Address - Country:US
Mailing Address - Phone:231-733-8650
Mailing Address - Fax:
Practice Address - Street 1:560 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3720
Practice Address - Country:US
Practice Address - Phone:231-733-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801070294101YM0800X, 104100000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712452Medicaid
MI20366Medicare UPIN
MI20386Medicare UPIN
MI20378Medicare UPIN
MI20351Medicare UPIN