Provider Demographics
NPI:1851469068
Name:REYNOLDS, DAVID B (D MIN)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 ELM ST
Mailing Address - Street 2:MANNING HOUSE
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2528
Mailing Address - Country:US
Mailing Address - Phone:603-627-2702
Mailing Address - Fax:603-627-3643
Practice Address - Street 1:2013 ELM ST
Practice Address - Street 2:MANNING HOUSE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2528
Practice Address - Country:US
Practice Address - Phone:603-627-2702
Practice Address - Fax:603-627-3643
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH36101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99001892Medicaid