Stacey Kathleen Reynolds

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

4650 E 16TH St
Tucson, AZ 85711-4232

Phone

(520) 499-8945

NPI assigned

Apr 17, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Stacey Kathleen Wilson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1972299501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 E 16TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857114232",
            "telephone_number": "520-499-8945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 E 16TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857114232",
            "telephone_number": "520-499-8945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "GreenLight ABA AZ, LLC",
            "address_2": "6700 E. Speedway Blvd, Ste 401",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "85710",
            "country_code": "US",
            "telephone_number": "877-881-3090",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Centria Healthcare Llc",
            "address_2": "27777 Inkster Rd Ste. 100",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483345310",
            "country_code": "US",
            "telephone_number": "248-436-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "STACEY",
        "middle_name": "KATHLEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-17",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "WILSON",
            "middle_name": "KATHLEEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kayla Lorraine Reynolds, MD
• Kevyn James Reynolds, LMT
• Priscilla Williamson Reynolds, MSW
• Randall T Reynolds, MED
• Sarah Reynolds, MSW
• Wendy Hafke Reynolds, B.S.
• William Roy Reynolds, PA-C
• Jason Francisco Reynoso, MD
• Mariangela Ernestina Reynoso, FNP
• Tiana Reynoso

• Behavior Technician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Behavior Technician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.