Provider Demographics
NPI:1669088126
Name:REYNOLDS, TAMMY L
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
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 1:1803 N SOUND DR
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-7697
Mailing Address - Country:US
Mailing Address - Phone:360-854-7400
Mailing Address - Fax:360-854-7446
Practice Address - Street 1:1803 N SOUND DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-7697
Practice Address - Country:US
Practice Address - Phone:360-854-7400
Practice Address - Fax:360-854-7446
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health