Provider Demographics
NPI:1871991471
Name:REYNOLDS, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27273 FM 2090 RD
Mailing Address - Street 2:
Mailing Address - City:SPLENDORA
Mailing Address - State:TX
Mailing Address - Zip Code:77372-4632
Mailing Address - Country:US
Mailing Address - Phone:832-226-6556
Mailing Address - Fax:
Practice Address - Street 1:27273 FM 2090 RD
Practice Address - Street 2:
Practice Address - City:SPLENDORA
Practice Address - State:TX
Practice Address - Zip Code:77372-4632
Practice Address - Country:US
Practice Address - Phone:832-226-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3781-3782324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility