Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Theo Reynolds

Individual provider Mental Health Counselor · NPI 1053269936

Theo Reynolds is a Mental Health Counselor in Oakland, California. Qualified in 2011, 15 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
15
Licensed in
OR
In the registry since
2026
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Practice location Address checks out

6810 Broadway Ter
Oakland, CA 94611-1907
Phone: (408) 623-1970
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence C5658 (OR)

Record details

NPI number1053269936
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 17, 2026
Last updated in NPPESMarch 17, 2026
Certification dateMarch 17, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Oakland