Provider Demographics
NPI:1619588878
Name:KINNEY, JAREB LEE (LAPC)
Entity Type:Individual
Prefix:MR
First Name:JAREB
Middle Name:LEE
Last Name:KINNEY
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 1/2 E BROADWAY AVE
Mailing Address - Street 2:#106
Mailing Address - City:BISMARK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-751-0443
Mailing Address - Fax:701-751-1616
Practice Address - Street 1:515 1/2 E BROADWAY AVE
Practice Address - Street 2:#106
Practice Address - City:BISMARK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-751-0443
Practice Address - Fax:701-751-1616
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1055-31-20A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional