1. Home
  2. Directory
  3. California
  4. Oakland
  5. Counselor
  6. NPI Profile

THEO REYNOLDS
NPI 1053269936
Counselor - Mental Health in Oakland, CA

Active since March 17, 2026PECOS EnrolledAccepts Medicare Assignment
6810 BROADWAY TER, OAKLAND, CA 94611(408) 623-1970 Get Directions Write a Review

NPPES record last updated: March 17, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Theo Reynolds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THEO REYNOLDS (NPI 1053269936) is an individual mental health provider in Oakland, California, licensed in Oregon (C5658) and active in the NPI registry since March 2026. He is enrolled in Medicare PECOS and is a graduate of Other (2011).

NPPES Registry Identity

NPI1053269936
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameTHEO REYNOLDS
Location Address6810 BROADWAY TEROakland, CA 94611-1907
Mailing Address6810 Broadway TerOakland, CA 94611-1907 · (408) 623-1970
Phone(408) 623-1970
Sole ProprietorYes
Medical School CMSOtherGraduated 2011
Enumeration DateMarch 17, 2026
NPPES CertifiedMarch 17, 2026
✔ NPI 1053269936 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in OR · C5658
6810 BROADWAY TER, Oakland, CA 94611
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Theo Reynolds is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1951870807
PECOS Enrollment IDI20260520001503
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theo Reynolds's NPI number?

The NPI number for Theo Reynolds is 1053269936. It was assigned to this individual provider in the NPPES registry on March 17, 2026.

Where is Theo Reynolds located?

Theo Reynolds practices at 6810 Broadway Ter, Oakland, CA 94611. The listed phone number is (408) 623-1970.

What is Theo Reynolds's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Theo Reynolds enrolled in Medicare?

Yes. Theo Reynolds is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Theo Reynolds was last updated on March 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.