Provider Demographics
NPI:1164782702
Name:MAXWELL, REYNELDA FELDER (MA, CART, LPC)
Entity type:Individual
Prefix:MRS
First Name:REYNELDA
Middle Name:FELDER
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MA, CART, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 WHEATSTONE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5448
Mailing Address - Country:US
Mailing Address - Phone:832-609-2196
Mailing Address - Fax:
Practice Address - Street 1:2224 N CRAYCROFT RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2811
Practice Address - Country:US
Practice Address - Phone:520-896-1400
Practice Address - Fax:520-614-6050
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZ21660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370301901Medicaid