David Af Raynolds, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C0943 Issued in OR

Practice address

600 Siskiyou Blvd
Ashland, OR 97520-2140

Phone

(541) 821-6623

Fax

(541) 535-1778

NPI assigned

Jul 21, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Nando Raynolds Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1619998010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 503010",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975030813",
            "telephone_number": "541-941-7792",
            "fax_number": "503-419-4662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SISKIYOU BLVD",
            "city": "ASHLAND",
            "state": "OR",
            "postal_code": "975202140",
            "telephone_number": "541-821-6623",
            "fax_number": "541-535-1778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYNOLDS",
        "first_name": "DAVID",
        "middle_name": "AF",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "C0943",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C0943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANDO",
            "last_name": "RAYNOLDS",
            "credential": "MA, LPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Professional Counselor in Ashland, OR
• Providers in Ashland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.