Healthcare Provider Details

I. General information

NPI: 1881110633
Provider Name (Legal Business Name): JULIE REINHART THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 SW COLUMBIA ST STE D
BEND OR
97702-1020
US

IV. Provider business mailing address

1633 NW PROMONTORY DRIVE
BEND OR
97703
US

V. Phone/Fax

Practice location:
  • Phone: 541-610-5659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberTO451
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22363
License Number StateOR

VIII. Authorized Official

Name: JULIE GIROUARD REINHART
Title or Position: THERAPIST
Credential: LMFT, LMT, MAC, ACS
Phone: 541-610-5659