Provider Demographics
NPI:1063203545
Name:REYNOLDS, TUCKER (LCMHC)
Entity type:Individual
Prefix:
First Name:TUCKER
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14309 S MAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8177
Mailing Address - Country:US
Mailing Address - Phone:801-688-6873
Mailing Address - Fax:
Practice Address - Street 1:14309 S MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8177
Practice Address - Country:US
Practice Address - Phone:801-688-6873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13411968-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health