Nicole R Reynolds, PSYD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301016052 Issued in MI

Practice address

158 N Main St
Plymouth, MI 48170-1236

Phone

(248) 736-5067

NPI assigned

Sep 4, 2009

Sex

Female

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

Medicare fee-for-service enrollment

Enrolled in MI, MD2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nicole Reynolds PSYD LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plymouth, MI
  • NPI 1316306418

  MD

  Medicare reassignment Authorized official
• Stephanie Williams, PHD, LP, PLLC

  • Clinical Psychologist
  • Ferndale, MI
  • NPI 1740512979
  NPD (past)

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

{
    "created_epoch": "1252022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481241600000",
    "number": "1285967422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20789 SUNNYDALE ST",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483365254",
            "telephone_number": "248-736-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 N MAIN ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701236",
            "telephone_number": "248-736-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "NICOLE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-04",
        "last_updated": "2016-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301016052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER TRANSACTION ACCESS NUMBER (PTAN)",
            "identifier": "MI9741001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marah Retli
• Beverly Reynolds
• Collin Reynolds
• Devon Reynolds
• Kelsey Reynolds
• Kimberly Anne Rhein, MA LPC CAADC SCL NCC
• Ashley Marie Rich, D.C.
• Kristin Rae Rich, BA, AAS, CNIM
• Richard L. Semlow D.C, P.C
• Kaelyn Richard

• Clinical Psychologist in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2016; 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.

Verify at the official NPI Registry.