Wallace Averal Reynolds Jr, PHD is a
Psychologist based in Bartow, Florida. Wallace Averal Reynolds Jr is licensed to practice in Florida (license number PSY-6775) and his current practice location is
1625 S Hibiscus Dr, Bartow, Florida. He can be reached at his office (for appointments etc.) via phone at
(863) 398-5996.
NPI number for Wallace Averal Reynolds Jr is 1942457189 and his current mailing address is 1625 S Hibiscus Dr, Bartow, Florida. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1942457189.
Healthcare Provider's Profile
| Full Name | Wallace Averal Reynolds Jr |
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| Gender | Male |
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| Speciality | Psychologist |
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| Location | 1625 S Hibiscus Dr, Bartow, Florida |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1942457189
- Provider Enumeration Date: 08/19/2008
- Last Update Date: 12/23/2014
Medical Identifiers
Medical identifiers for Wallace Averal Reynolds Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1942457189 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103T00000X | Psychologist | PSY-6775 (Florida) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Wallace Averal Reynolds Jr is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Wallace Averal Reynolds Jr, PHD
1625 S Hibiscus Dr,
Bartow, FL 33830-7242
Ph: (863) 398-5996 | Wallace Averal Reynolds Jr, PHD
1625 S Hibiscus Dr,
Bartow, FL 33830-7242
Ph: (863) 398-5996 |
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