Provider Demographics
NPI:1417587403
Name:REACH PLLC
Entity Type:Organization
Organization Name:REACH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEA
Authorized Official - Middle Name:MEGEN
Authorized Official - Last Name:MCMARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:651-587-6826
Mailing Address - Street 1:2840 TIMBERLANE WAY SW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8245
Mailing Address - Country:US
Mailing Address - Phone:651-587-6826
Mailing Address - Fax:
Practice Address - Street 1:2408 TRACY CT NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5638
Practice Address - Country:US
Practice Address - Phone:651-587-6825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-19
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty