Provider Demographics
NPI:1235206632
Name:REINHOLD, MINDY (MA LPC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:REINHOLD
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1235
Mailing Address - Country:US
Mailing Address - Phone:417-894-0180
Mailing Address - Fax:
Practice Address - Street 1:621 3RD AVE S
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1235
Practice Address - Country:US
Practice Address - Phone:417-894-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020021101YP2500X
WI3306-125101YP2500X
WI3306 125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40918600Medicare ID - Type Unspecified