Provider Demographics
NPI:1942892013
Name:VENABLE, JAMIE (RBT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:VENABLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:100 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3914
Mailing Address - Country:US
Mailing Address - Phone:701-389-9363
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST S
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3914
Practice Address - Country:US
Practice Address - Phone:013-899-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-18-52445106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician