Individual
NICOLE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
021347
NY
103T00000X
Psychologist
100367
OR
103TC0700X
Clinical Psychologist
Primary
PSY.0005798
CO
Other
Enumeration date
09/14/2015
Last updated
08/22/2022
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