Provider Demographics
NPI:1356580666
Name:REYNOLDS, DAVID MICHAEL (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 S. GERMAN LANE #1
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7870
Mailing Address - Country:US
Mailing Address - Phone:501-358-6606
Mailing Address - Fax:501-325-5554
Practice Address - Street 1:855 S. GERMAN LANE #1
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7203
Practice Address - Country:US
Practice Address - Phone:501-358-6606
Practice Address - Fax:501-325-5554
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P1104025101YP2500X
ARP1710360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
5AE49OtherBCBS