Provider Demographics
NPI:1861558439
Name:REYNOLDS, IRENA SOPHIA (MS)
Entity type:Individual
Prefix:MS
First Name:IRENA
Middle Name:SOPHIA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-1311
Mailing Address - Country:US
Mailing Address - Phone:360-698-9258
Mailing Address - Fax:360-698-9296
Practice Address - Street 1:7500 OLD MILITARY RD NE
Practice Address - Street 2:SUITE 103
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3241
Practice Address - Country:US
Practice Address - Phone:360-698-9258
Practice Address - Fax:360-698-9296
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health