Provider Demographics
NPI:1972345015
Name:REINBOLD, DEBRA ANNE
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANNE
Last Name:REINBOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 OAK RIVER CT NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9317
Mailing Address - Country:US
Mailing Address - Phone:616-286-0120
Mailing Address - Fax:
Practice Address - Street 1:1388 BALDWIN ST STE A
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8937
Practice Address - Country:US
Practice Address - Phone:616-259-9220
Practice Address - Fax:616-296-2148
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health