Provider Demographics
NPI:1679307177
Name:REYNOLDS, ALYSSA (MED)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 S BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2208
Mailing Address - Country:US
Mailing Address - Phone:314-529-1391
Mailing Address - Fax:855-295-0738
Practice Address - Street 1:1612 S BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-2208
Practice Address - Country:US
Practice Address - Phone:314-529-1391
Practice Address - Fax:855-295-0738
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health