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Individual
SUSAN REYNOLDS
Active
Individual
SUSAN REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA MFT
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
08/19/2008
Last updated
08/19/2008
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