Provider Demographics
NPI:1902055353
Name:MCREYNOLDS, EMILY TAYLOR
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:TAYLOR
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 GREGORY BLVD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-2745
Mailing Address - Country:US
Mailing Address - Phone:228-523-5000
Mailing Address - Fax:228-523-4384
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:SOCIAL WORK SERVICE (122)
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical