| NPI | 1225104037 |
|---|---|
| Former Name | PHYLLIS J REYNOLDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY 777) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 434) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2009-03-18 |