Matthew Rudd Reynolds

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

R5679 Issued in OR

Practice address

2929 SW Multnomah Blvd Ste 203B
Portland, OR 97219-4070

Phone

(503) 388-7011

NPI assigned

Nov 12, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1154923308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 SW MULTNOMAH BLVD STE 203B",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972194070",
            "telephone_number": "503-388-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 SW MULTNOMAH BLVD STE 203B",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972194070",
            "telephone_number": "503-388-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "MATTHEW",
        "middle_name": "RUDD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-12",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R5679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF COUNSELORS AND THERAPISTS",
            "identifier": "R5679",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matt@rcsdeaftherapy.com",
            "affiliation": "N",
            "endpointDescription": "Work E-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "E-mail",
            "address_1": "2929 SW Multnomah Blvd Ste 203B",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972194070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John Devaux Reynolds, N.D.
• Kimberly Guion Reynolds, PHD
• Lawrence Reynolds
• Lindsey Kinna Reynolds, LMT
• Lisa A Reynolds, MD
• Nancy Louise Reynolds, LCSW,RN
• Olivia Reynolds, PSY.D.
• Ricco Cory Reynolds, FNP-C
• Sharon Elizabeth Reynolds, MN, FNP
• Stephen M Reynolds, LCSW

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.