Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003227174 |
---|---|
Provider Name | Jaclyn Reynolds |
First Address | Bellingham, WA 98226-4414 |
Second Address | Bellingham, WA 98226-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 12/05/2014 |