Active NPI
Kim Stephan Reynolds, CPSW
- Mental Health Counselor
- Taos, NM
National Provider Identifier
1700456746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 501 Paseo del Pueblo Norte
Taos, NM 87571 - Phone
- (575) 758-2692
- Fax
- (575) 751-5105
- NPI assigned
- Jul 1, 2021
- Last updated
- Jul 1, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NU | Primary |
Addresses
Primary practice location
501 Paseo del Pueblo Norte
Taos, NM 87571
Mailing address
PO Box 1846
Taos, NM 87571-1846
Phone (575) 758-2692
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295971505 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625097600000",
"number": "1700456746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1846",
"city": "TAOS",
"state": "NM",
"postal_code": "875711846",
"telephone_number": "575-758-2692",
"fax_number": "575-751-5105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 PASEO DEL PUEBLO NORTE",
"city": "TAOS",
"state": "NM",
"postal_code": "87571",
"telephone_number": "575-758-2692",
"fax_number": "575-751-5105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "KIM",
"middle_name": "STEPHAN",
"credential": "CPSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-01",
"last_updated": "2021-07-01",
"certification_date": "2021-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1295971505",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Taos, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.