Individual
MR. MAC PATRIK REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS. PSYCHOLOGY
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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