MEDICARE: MS. JEANNE KAY RAINES MS (MHC), NCC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	39000106A	IN

General Provider Information

NPI Number	:	1659581239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE KAY RAINES MS (MHC), NCC, LMHC

Provider Business Mailing Address
First Line	:	2000 N WELLS ST
Second Line	:	BUILDING 1, STE. 1101
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-2474
Country	:	US
Telephone Number	:	260-341-9192
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N WELLS ST
Second Line	:	BUILDING 1, STE. 1101
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-2474
Country	:	US
Telephone Number	:	260-341-9192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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