Organization
DR. NICOLE REYNOLDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE MARIE REYNOLDS PSYD (CLINICAL PSYCHOLOGIST)
(770) 883-3038
Entity
Organization
Contact information
Practice address
271 3RD ST, ASTORIA, OR 97103-4311
(770) 883-3038
Mailing address
271 3RD ST, ASTORIA, OR 97103-4311
(770) 883-3038
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
103TH0004X
Health Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500732686
—
OR
Enumeration date
05/04/2020
Last updated
05/04/2020
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