Provider Demographics
NPI:1831587351
Name:REYNOLDS, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 CANVAS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0273
Mailing Address - Country:US
Mailing Address - Phone:702-269-4722
Mailing Address - Fax:
Practice Address - Street 1:3606 N RANCHO DR STE 144
Practice Address - Street 2:SUITE 102 # 4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3196
Practice Address - Country:US
Practice Address - Phone:702-658-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health