Wallace Averal Reynolds Jr., PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY-6775 Issued in FL

Practice address

1625 S Hibiscus Dr
Bartow, FL 33830-7242

Phone

(863) 398-5996

NPI assigned

Aug 19, 2008

Last updated

Dec 23, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Evelyn M Frye Clinical Associates, PC

  • Counselor
  • Nashville, TN
  • NPI 1578514923

  Psychologist

  NPD (past)

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419292800000",
    "number": "1942457189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 S HIBISCUS DR",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338307242",
            "telephone_number": "863-398-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 S HIBISCUS DR",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338307242",
            "telephone_number": "863-398-5996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "WALLACE",
        "middle_name": "AVERAL",
        "name_suffix": "Jr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-19",
        "last_updated": "2014-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PSY-6775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Remyn
• Ashley Retton
• Heidi Sue Reves, FNP
• Rex Primary Care Provider, NP LLC (Decker Primary Care)
• Barbara Elizabeth Reyna, MSW
• Rfi Group Inc. (Tender Touch Homecare and Companion Services)
• Ricardo Arguello, M.D. (Children's Medical Center)
• Melissa Rice
• Katherine Rich
• Ashley Nicole Richards, CASEMANAGER

• Psychologist in Bartow, FL
• Providers in Bartow, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; 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.