Provider Demographics
NPI:1992015226
Name:REYNOLDS, BROOKE (LMFT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1716
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85636-1716
Mailing Address - Country:US
Mailing Address - Phone:520-255-1421
Mailing Address - Fax:520-255-1421
Practice Address - Street 1:4669 N COMMERCE DR STE 4A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2497
Practice Address - Country:US
Practice Address - Phone:520-255-1421
Practice Address - Fax:520-417-9729
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10301106H00000X
AZLMFT-10407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ228604Medicaid