Individual
MR. DONALD REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC. CSAC
Contact information
Practice address
20 SHERMAN AVE E, FORT ATKINSON, WI 53538-1864
(920) 728-1810
Mailing address
615 N 4TH ST, FORT ATKINSON, WI 53538-1919
(920) 728-1810
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16206-132
WI
101YM0800X
Mental Health Counselor
6746-125
WI
101YP2500X
Professional Counselor
Primary
6746125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100078435
—
WI
Enumeration date
06/12/2018
Last updated
03/23/2021
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