Provider Demographics
NPI:1063898609
Name:MCREYNOLDS, KRISTI (LCSW, RPT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:LCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 N CAMPBELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1448
Mailing Address - Country:US
Mailing Address - Phone:520-500-6483
Mailing Address - Fax:520-495-4259
Practice Address - Street 1:3801 N CAMPBELL AVE STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1448
Practice Address - Country:US
Practice Address - Phone:520-500-6483
Practice Address - Fax:520-495-4259
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-153891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-15389OtherSTATE LICENSE
AZ042799Medicaid