Provider Demographics
NPI:1891063210
Name:REICHENBACH, DEBORAH J (MDIV, MA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:REICHENBACH
Suffix:
Gender:F
Credentials:MDIV, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 S MAIN ST
Mailing Address - Street 2:P O BOX 277
Mailing Address - City:MARENGO
Mailing Address - State:IN
Mailing Address - Zip Code:47140-3100
Mailing Address - Country:US
Mailing Address - Phone:812-365-2770
Mailing Address - Fax:
Practice Address - Street 1:164 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IN
Practice Address - Zip Code:47140-3100
Practice Address - Country:US
Practice Address - Phone:812-365-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001696A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39001696AOtherMENTAL HEALTH COUNSELOR