NPIMap

Organization Active NPI

Nicole Reynolds PSYD LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plymouth, MI
National Provider Identifier
1316306418
Registry record updated Feb 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
6301016052 Issued in MI
Legal business name
NICOLE REYNOLDS PSYD LLC
Practice address
158 N Main St
Plymouth, MI 48170-1236
Phone
(248) 736-5067
NPI assigned
Feb 17, 2016
Last updated
Feb 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2016

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

Authorized official

Name
Dr. Nicole R Reynolds, PSYD, LPNPI 1285967422
Title
Owner/Operator
Phone
(248) 736-5067

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 6301016052 MI Primary

Addresses

Primary practice location

158 N Main St
Plymouth, MI 48170-1236

Mailing address

20789 Sunnydale St
Farmington Hills, MI 48336-5254
Phone (248) 736-5067

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160421000734 MI Part B Supplier - Clinic/Group Practice 4981902145 Receives reassigned benefits from 1 practitioner
Practice locations: East Lansing, MI
O20250127000112 MD Part B Supplier - Clinic/Group Practice 4981902145 Receives reassigned benefits from 1 practitioner
Practice locations: Salisbury, MD

National Provider Directory

National Provider Directory

Locations

39319 Plymouth Rd
Ste 2
Livonia, MI 48150
Phone (248) 259-1991

158 N Main St
Plymouth, MI 48170
Phone (248) 259-1991

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455667200000",
    "number": "1316306418",
    "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": {
        "organization_name": "NICOLE REYNOLDS PSYD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-17",
        "last_updated": "2016-02-17",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "248-736-5067",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MI",
            "license": "6301016052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.