| Dr. Nicole Reynolds Llc | |
|
271 3rd St Astoria OR 97103-4311 | |
| (770) 883-3038 | |
| Not Available |
| Full Name | Dr. Nicole Reynolds Llc |
|---|---|
| Speciality | Psychologist |
| Location | 271 3rd St, Astoria, Oregon |
| Authorized Official Name and Position | Nicole Marie Reynolds (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 7708833038 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Nicole Reynolds Llc 271 3rd St Astoria OR 97103-4311 Ph: (770) 883-3038 | Dr. Nicole Reynolds Llc 271 3rd St Astoria OR 97103-4311 Ph: (770) 883-3038 |
| NPI Number | 1740801455 |
|---|---|
| Provider Enumeration Date | 05/04/2020 |
| Last Update Date | 05/04/2020 |
| Certification Date | 05/04/2020 |
| Medicare PECOS PAC ID | 5597186395 |
|---|---|
| Medicare Enrollment ID | O20200603001599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740801455 | NPI | - | NPPES |
| 500732686 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 103TH0004X | Psychologist - Health | (* (Not Available)) | Secondary |
| Provider Name | Nicole M Reynolds |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598133043 PECOS PAC ID: 7214226224 Enrollment ID: I20171121003017 |
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