Provider Demographics
NPI:1528538337
Name:REINECCIUS, TRISTEN MARIE HANES
Entity Type:Individual
Prefix:
First Name:TRISTEN
Middle Name:MARIE HANES
Last Name:REINECCIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRISTEN
Other - Middle Name:MARIE
Other - Last Name:HANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21600 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:496 OLD ROUTE 66
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-3728
Practice Address - Country:US
Practice Address - Phone:573-246-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst