Provider Demographics
NPI:1962273870
Name:JULIE A REYNOLDS LLC
Entity type:Organization
Organization Name:JULIE A REYNOLDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:210-685-8974
Mailing Address - Street 1:220 E 5TH ST UNIT 8083
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2943
Mailing Address - Country:US
Mailing Address - Phone:210-685-8974
Mailing Address - Fax:
Practice Address - Street 1:112 W 4TH ST STE 5
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4311
Practice Address - Country:US
Practice Address - Phone:210-685-8974
Practice Address - Fax:208-883-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty