Provider Demographics
NPI:1588411961
Name:REYNOLDS, ANDORA N (PSS/CRM)
Entity type:Individual
Prefix:
First Name:ANDORA
Middle Name:N
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PSS/CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 N ELDORADO AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6423
Mailing Address - Country:US
Mailing Address - Phone:541-883-3471
Mailing Address - Fax:
Practice Address - Street 1:2545 N ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6423
Practice Address - Country:US
Practice Address - Phone:541-883-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR110582101YM0800X
OR24-CRM-3292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health