Provider Demographics
NPI:1770058018
Name:REYNOLDS, RACHEL JAYNE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JAYNE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-218-2256
Mailing Address - Fax:606-218-6577
Practice Address - Street 1:131 SUMMIT DR FL 3
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1580
Practice Address - Country:US
Practice Address - Phone:606-218-2256
Practice Address - Fax:606-218-6577
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY243432103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-29633OtherBCBA CERTIFICATE