Provider Demographics
NPI:1154806693
Name:REYNOLDS, TAMMY (BACHELOR'S)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BACHELOR'S
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1799 STUMPF BLVD BLDG 7
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3950
Mailing Address - Country:US
Mailing Address - Phone:844-864-7834
Mailing Address - Fax:844-864-7834
Practice Address - Street 1:1799 STUMPF BLVD BLDG 7
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:844-864-7834
Practice Address - Fax:844-864-7834
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator