Healthcare Provider Details

I. General information

NPI: 1881094480
Provider Name (Legal Business Name): JASON RIEBE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 ROCKSIDE RD STE 400
INDEPENDENCE OH
44131-2159
US

IV. Provider business mailing address

7926 OAKRIDGE DR
MENTOR OH
44060-7276
US

V. Phone/Fax

Practice location:
  • Phone: 216-642-8283
  • Fax: 216-937-0187
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number7191
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number7191
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7191
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7191
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7191
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number7191
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number7191
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number7191
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number7191
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number7191
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: