Provider Demographics
NPI:1871002865
Name:REYNOLDS, DENAY M
Entity Type:Individual
Prefix:
First Name:DENAY
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 DELMAR BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1094
Mailing Address - Country:US
Mailing Address - Phone:618-531-9003
Mailing Address - Fax:
Practice Address - Street 1:5261 DELMAR BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1094
Practice Address - Country:US
Practice Address - Phone:618-531-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities