Healthcare Provider Details

I. General information

NPI: 1073949574
Provider Name (Legal Business Name): JEFFREY A REINING DR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 SPENCER ST NE
GRAND RAPIDS MI
49505-5207
US

IV. Provider business mailing address

641 SPENCER ST NE
GRAND RAPIDS MI
49505-5207
US

V. Phone/Fax

Practice location:
  • Phone: 815-355-1403
  • Fax:
Mailing address:
  • Phone: 815-355-1403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: