Provider Demographics
NPI:1750733804
Name:REYNOLDS, SANDRA SUE (MA,LLPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA,LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2301 E MICHIGAN AVE STE 101
Mailing Address - Street 2:P.O. 6159
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3765
Mailing Address - Country:US
Mailing Address - Phone:517-783-3434
Mailing Address - Fax:517-782-6446
Practice Address - Street 1:101 SPRING ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1160
Practice Address - Country:US
Practice Address - Phone:517-437-0114
Practice Address - Fax:517-782-6446
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health