Provider Demographics
NPI:1285435743
Name:RAYNOCK, JAKE THOMAS
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:THOMAS
Last Name:RAYNOCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 CLUBHOUSE WAY APT 4
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3448
Mailing Address - Country:US
Mailing Address - Phone:406-855-4224
Mailing Address - Fax:
Practice Address - Street 1:12 AVANTA WAY STE 2
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6921
Practice Address - Country:US
Practice Address - Phone:406-272-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-720951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical