Individual
GABRIELLE REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3003 HUALAPAI MOUNTAIN RD LOT 8, KINGMAN, AZ 86401-5390
(520) 748-7108
Mailing address
1161 N EL DORADO PL STE 103, TUCSON, AZ 85715-4607
(928) 919-2927
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
AZ
385HR2055X
Child Mental Illness Respite Care
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215181219
—
AZ
Enumeration date
11/05/2008
Last updated
10/13/2022
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