Provider Demographics
NPI:1891218103
Name:REYNOLDS, HANNAH GRACE (MED, LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MED, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 STONEWAY CLOSE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4538
Mailing Address - Country:US
Mailing Address - Phone:865-776-3942
Mailing Address - Fax:
Practice Address - Street 1:3415 W END AVE STE A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1077
Practice Address - Country:US
Practice Address - Phone:615-547-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3878101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional