Provider Demographics
NPI:1407008360
Name:REINARTS, JACOB DALE (LAC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DALE
Last Name:REINARTS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:REINARTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2504 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401
Mailing Address - Country:US
Mailing Address - Phone:701-253-3755
Mailing Address - Fax:701-253-3757
Practice Address - Street 1:2504 CIRCLE DR # 58401
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-253-3755
Practice Address - Fax:701-253-3757
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1590101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)