Healthcare Provider Details

I. General information

NPI: 1972795979
Provider Name (Legal Business Name): KIMBERLY ANNE RHEIN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14960 E PARK ST
CAPAC MI
48014-3177
US

IV. Provider business mailing address

31249 EVENINGSIDE
FRASER MI
48026-3325
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-3584
  • Fax: 810-395-2985
Mailing address:
  • Phone: 586-293-4812
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401010451
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6401010451
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: