Individual
KELLIE REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9900 N CENTRAL EXPY, SUITE 300, DALLAS, TX 75231-4395
(214) 265-0420
(817) 789-6849
Mailing address
305 NE LOOP 820, BUSINESS TOWER 1; SUITE 200, HURST, TX 76053-7209
(817) 292-8787
(817) 789-6849
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
008601
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149984001
—
TX
05
—
207164901
—
TX
Enumeration date
04/25/2013
Last updated
04/25/2013
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