Donald Reynolds, LPC. CSAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6746125 Issued in WI

Practice address

20 Sherman Ave E
Fort Atkinson, WI 53538-1864

Phone

(920) 728-1810

NPI assigned

Jun 12, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

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.

• Im Fine Counseling Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Atkinson, WI
  • NPI 1023642725
  NPD Authorized official
• American Behavioral Clinics, SC

  • Psychiatry Physician
  • Milwaukee, WI
  • NPI 1144313859
  NPD (past)
• Credence Therapy Associates Inc

  dba Credence Therapy Associates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elkhorn, WI
  • NPI 1487648663
  NPD (past)

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1922591254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N 4TH ST",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381919",
            "telephone_number": "920-728-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 SHERMAN AVE E",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381864",
            "telephone_number": "920-728-1810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 1/2 W Geneva St",
            "address_purpose": "LOCATION",
            "city": "Elkhorn",
            "state": "WI",
            "postal_code": "531211722",
            "country_code": "US",
            "telephone_number": "262-723-3424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "DONALD",
        "name_prefix": "Mr.",
        "credential": "LPC. CSAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-12",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "6746-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "6746125",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16206-132",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100078435",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Fort Atkinson, WI
• Providers in Fort Atkinson, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.