Active NPI
Theo Reynolds
- Mental Health Counselor
- Oakland, CA
National Provider Identifier
1053269936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- C5658
- Practice address
- 6810 Broadway Ter
Oakland, CA 94611-1907 - Phone
- (408) 623-1970
- NPI assigned
- Mar 17, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C5658 | OR | Primary |
Addresses
Primary practice location
6810 Broadway Ter
Oakland, CA 94611-1907
Mailing address
6810 Broadway Ter
Oakland, CA 94611-1907
Phone (408) 623-1970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260520001503 | OR | Practitioner - Mental Health Counselor | 1951870807 | Practice locations: Portland, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
Portland, OR 97239
Phone (408) 623-1970
6810 Broadway Ter
Oakland, CA 94611-1907
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C5658 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773705600000",
"number": "1053269936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6810 BROADWAY TER",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946111907",
"telephone_number": "408-623-1970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6810 BROADWAY TER",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946111907",
"telephone_number": "408-623-1970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "THEO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-03-17",
"last_updated": "2026-03-17",
"certification_date": "2026-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "C5658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.