| Nicole Reynolds Psyd Llc | |
|
158 N Main St Plymouth MI 48170-1236 | |
| (248) 736-5067 | |
| Not Available |
| Full Name | Nicole Reynolds Psyd Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 158 N Main St, Plymouth, Michigan |
| Authorized Official Name and Position | Nicole R Reynolds (OWNER/OPERATOR) |
| Authorized Official Contact | 2487365067 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Reynolds Psyd Llc 20789 Sunnydale St Farmington Hills MI 48336-5254 Ph: (248) 736-5067 | Nicole Reynolds Psyd Llc 158 N Main St Plymouth MI 48170-1236 Ph: (248) 736-5067 |
| NPI Number | 1316306418 |
|---|---|
| Provider Enumeration Date | 02/17/2016 |
| Last Update Date | 02/17/2016 |
| Medicare PECOS PAC ID | 4981902145 |
|---|---|
| Medicare Enrollment ID | O20160421000734 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316306418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 6301016052 (Michigan) | Primary |
| Provider Name | Nicole Rena Reynolds |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285967422 PECOS PAC ID: 5890093058 Enrollment ID: I20170109002361 |
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