Provider Demographics
NPI:1215071873
Name:REYNOLDS, HEATHER M (MA,)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 S MAIN ST
Mailing Address - Street 2:UNITY A
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4740
Mailing Address - Country:US
Mailing Address - Phone:419-352-4624
Mailing Address - Fax:419-354-1774
Practice Address - Street 1:1084 S MAIN ST
Practice Address - Street 2:UNITY A
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4740
Practice Address - Country:US
Practice Address - Phone:419-352-4624
Practice Address - Fax:419-354-1774
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500073101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral