Active NPI
Jeanmarie Reynolds, LPC
- Professional Counselor
- Maryland Heights, MO
National Provider Identifier
1790858751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2000171103
- Practice address
- 75 Midland Ave
Maryland Heights, MO 63043-2625 - Phone
- (314) 583-8377
- NPI assigned
- Nov 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2000171103 | MO | |
| Professional Counselor | 101YP2500X | 2000171103 | MO | Primary |
Addresses
Primary practice location
75 Midland Ave
Maryland Heights, MO 63043-2625
Mailing address
2784 Corral Est
Arnold, MO 63010-4102
Phone (314) 583-8377
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001273705 | Other | MO | CTS VENDOR NUMBER |
| 494847809 | Medicaid | MO | |
| 164436 | Other | MO | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 16, 2025 through Jul 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000171103 | MO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705017600000",
"number": "1790858751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2784 CORRAL EST",
"city": "ARNOLD",
"state": "MO",
"postal_code": "630104102",
"telephone_number": "314-583-8377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 MIDLAND AVE",
"city": "MARYLAND HEIGHTS",
"state": "MO",
"postal_code": "630432625",
"telephone_number": "314-583-8377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "JEANMARIE",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-16",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2000171103",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2000171103",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CTS VENDOR NUMBER",
"identifier": "001273705",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "494847809",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "164436",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maryland Heights, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.