Provider Demographics
NPI:1154782167
Name:REYNOLDS, WILLIAM M
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
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 1:3294 ROYAL DR
Mailing Address - Street 2:STE 13
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8500
Mailing Address - Country:US
Mailing Address - Phone:415-218-3850
Mailing Address - Fax:
Practice Address - Street 1:1032 IRVING ST.
Practice Address - Street 2:PMB 321
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122
Practice Address - Country:US
Practice Address - Phone:415-218-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical