Individual
WALLACE AVERAL REYNOLDS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1625 S HIBISCUS DR, BARTOW, FL 33830-7242
(863) 398-5996
Mailing address
1625 S HIBISCUS DR, BARTOW, FL 33830-7242
(863) 398-5996
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-6775
FL
Other
Enumeration date
08/19/2008
Last updated
12/23/2014
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