Individual provider Active NPI

David Michael Reynolds, LPC

  • Professional Counselor
  • Conway, AR
National Provider Identifier
1356580666
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
P1710360 Issued in AR
Practice address
855 S. German Lane #1
Conway, AR 72034-7203
Phone
(501) 358-6606
Fax
(501) 325-5554
NPI assigned
Feb 10, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X P1104025
Professional Counselor 101YP2500X P1710360 AR Primary

Addresses

Primary practice location

855 S. German Lane #1
Conway, AR 72034-7203

Mailing address

855 S. German Lane #1
Conway, AR 72034-7870
Phone (501) 358-6606

Other identifiers 1

IdentifierTypeStateIssuer
5AE49OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240207000553 AR Practitioner - Mental Health Counselor 1052754066 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Counseling and Psychological Services PLLCGroup PAC ID 4183933781, 30 clinicians

Practice addresses (Care Compare)

855 S German LN
Suite 1
Conway, AR 72034-6479
Phone (501) 358-6606

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Counseling & Psychological Services, PLLC Professional CurrentSince Jan 6, 2024 Accepting new patients

Locations

855 S German Ln
Ste 1
Conway, AR 72034
Phone (501) 358-6606

2100 Spring Valley Dr
Conway, AR 72034
Phone (501) 404-0737

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1234224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1356580666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 S. GERMAN LANE #1",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720347870",
            "telephone_number": "501-358-6606",
            "fax_number": "501-325-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 S. GERMAN LANE #1",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720347203",
            "telephone_number": "501-358-6606",
            "fax_number": "501-325-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "DAVID",
        "middle_name": "MICHAEL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-10",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": "P1104025",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1710360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5AE49",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.