Provider Demographics
NPI:1932893526
Name:REYNOLDS, JOSEPH WILLIAM IV (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:REYNOLDS
Suffix:IV
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BOSA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-4643
Mailing Address - Country:US
Mailing Address - Phone:573-528-3510
Mailing Address - Fax:
Practice Address - Street 1:704 HISTORIC ROUTE 66 W
Practice Address - Street 2:SUITE 101
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-433-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023018578104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker