Individual
DR. NICOLE R REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
158 N MAIN ST, PLYMOUTH, MI 48170-1236
(248) 736-5067
Mailing address
20789 SUNNYDALE ST, FARMINGTON HILLS, MI 48336-5254
(248) 736-5067
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301016052
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI9741001
PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
MI
Enumeration date
09/04/2009
Last updated
12/09/2016
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