Provider Demographics
NPI:1285969915
Name:REYNOLDS, DENISE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 A W GRIMES BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5459
Mailing Address - Country:US
Mailing Address - Phone:512-423-0808
Mailing Address - Fax:
Practice Address - Street 1:2911 A W GRIMES BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5459
Practice Address - Country:US
Practice Address - Phone:512-423-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical