Provider Demographics
NPI:1962645044
Name:REYNOLDS, PAMELA JILL (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JILL
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21263 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3715
Mailing Address - Country:US
Mailing Address - Phone:818-592-3026
Mailing Address - Fax:
Practice Address - Street 1:2828 BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3103
Practice Address - Country:US
Practice Address - Phone:310-968-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist