Provider Demographics
NPI:1962860783
Name:REYNOLDS, KAYLIE LAUREN
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:LAUREN
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 1:4355 KEMPF ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1801
Mailing Address - Country:US
Mailing Address - Phone:248-766-6569
Mailing Address - Fax:
Practice Address - Street 1:1225 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1905
Practice Address - Country:US
Practice Address - Phone:248-524-8801
Practice Address - Fax:248-524-8855
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor