Individual
MR. MAC PATRIK REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS. PSYCHOLOGY
Contact information
Practice address
620 W PROSSER RD LOT H, CHEYENNE, WY 82007-3054
(307) 274-6567
Mailing address
620 W PROSSER RD LOT H, CHEYENNE, WY 82007-3054
(307) 274-6567
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
WY
253Z00000X
In Home Supportive Care Agency
—
WY
372600000X
Adult Companion
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
09/28/2020
Last updated
10/13/2020
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