Individual provider Active NPI

Brooke Reynolds, LMFT

  • Marriage & Family Therapist
  • Sierra Vista, AZ
National Provider Identifier
1992015226
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT-10407 Issued in AZ
Practice address
4669 N Commerce Dr Ste 4a
Sierra Vista, AZ 85635-2497
Phone
(520) 255-1421
NPI assigned
Oct 20, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LMFT-10407 AZ Primary

Addresses

Primary practice location

4669 N Commerce Dr Ste 4a
Sierra Vista, AZ 85635-2497

Mailing address

P.O. Box 1716
Sierra Vista, AZ 85636-1716
Phone (520) 255-1421

Other identifiers 1

IdentifierTypeStateIssuer
228604MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240529004204 AZ Practitioner - Marriage and Family Therapist 5294177796 Practice locations: Sierra Vista, AZ

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4669 N Commerce Dr
4A
Sierra Vista, AZ 85635-2497
Phone (520) 255-1421

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMFT-10407AZMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Inner-Balance Therapy PLLC Marriage & Family Therapist CurrentSince Aug 1, 2022 Accepting new patients

Locations

4669 N Commerce Dr
Ste 4A
Sierra Vista, AZ 85635
Phone (520) 255-1421

25 El Camino Real
Ste 4
Sierra Vista, AZ 85635
Phone (520) 220-6481

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1992015226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1716",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856361716",
            "telephone_number": "520-255-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4669 N COMMERCE DR STE 4A",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352497",
            "telephone_number": "520-255-1421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "BROOKE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-20",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "AZ",
            "license": "LMFT-10407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "228604",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

Verify at the official NPI Registry.