Provider Demographics
NPI:1407073786
Name:REYNOLDS, ASH KILLIAN (M ED)
Entity type:Individual
Prefix:
First Name:ASH
Middle Name:KILLIAN
Last Name:REYNOLDS
Suffix:
Gender:X
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER ST FL 3
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-2680
Mailing Address - Country:US
Mailing Address - Phone:413-540-1234
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2680
Practice Address - Country:US
Practice Address - Phone:413-437-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC7292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health