Provider Demographics
NPI:1508205295
Name:SMR COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SMR COUNSELING SERVICES, LLC
Other - Org Name:DR. SHAUNA MOORE REYNOLDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCP, LCPC, NCC
Authorized Official - Phone:240-389-1487
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-0275
Mailing Address - Country:US
Mailing Address - Phone:240-389-1487
Mailing Address - Fax:
Practice Address - Street 1:11785 BELTSVILLE DR STE 120
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:MD
Practice Address - Zip Code:20705-3121
Practice Address - Country:US
Practice Address - Phone:240-389-1487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPCR14291101Y00000X, 101YM0800X, 101YP2500X
MDLC4866101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0647632P0000Medicaid
MD889048000Medicaid