Provider Demographics
NPI:1427140771
Name:REYNOLDS, JOHN ALAN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 W ORANGEWOOD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2004
Mailing Address - Country:US
Mailing Address - Phone:714-221-6400
Mailing Address - Fax:714-221-6401
Practice Address - Street 1:1745 W ORANGEWOOD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2004
Practice Address - Country:US
Practice Address - Phone:714-221-6400
Practice Address - Fax:714-221-6401
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health