Provider Demographics
NPI:1649645052
Name:REYNOLDS, BERNADETTE (LCPC)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 DEWEY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3411
Mailing Address - Country:US
Mailing Address - Phone:406-498-4086
Mailing Address - Fax:
Practice Address - Street 1:1240 DEWEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3411
Practice Address - Country:US
Practice Address - Phone:406-498-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health