Doctor Name: | MISS KATHLEEN ELIZABETH REICHENBERG |
NPI Number: | 1366724643 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LAC |
License Number: | 1646 |
Business Practice Address: | 200 Highway 2 W Devils Lake, ND - 583013532 |
Business Phone Number: | 7016652200 |
Business Fax Number: | 7016652300 |
Mailing Address: | Po Box 650, DEVILS LAKE |
State: | ND |
Postal Code: | 583010650 |
Phone Number: | 7016652200 |
Fax Number: | 7016652300 |
NPI Enumeration Date: | 09/13/2011 |
NPI Last Update Date: | 03/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 1646 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |