Provider Demographics
NPI:1821367475
Name:TOOGOOD REYNOLDS, JUDITH ANN (MFTI CADAC II NCACII)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:TOOGOOD REYNOLDS
Suffix:
Gender:F
Credentials:MFTI CADAC II NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-2447
Mailing Address - Country:US
Mailing Address - Phone:707-544-5633
Mailing Address - Fax:
Practice Address - Street 1:2061 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-2447
Practice Address - Country:US
Practice Address - Phone:707-544-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
90503101YA0400X, 101YA0400X
CAMFTI 68143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist