Provider Demographics
NPI:1639197536
Name:RHEIN, JEFF A (PCC-SUPV)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:A
Last Name:RHEIN
Suffix:
Gender:M
Credentials:PCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 FUJITEC DR BLDG A
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8336
Mailing Address - Country:US
Mailing Address - Phone:513-228-7854
Mailing Address - Fax:513-228-7848
Practice Address - Street 1:201 READING RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1666
Practice Address - Country:US
Practice Address - Phone:513-398-2551
Practice Address - Fax:513-459-7300
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-4065-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000290378OtherANTHEM PIN