Provider Demographics
NPI:1831419142
Name:REIMAN, JOHN W (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:REIMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-0474
Mailing Address - Country:US
Mailing Address - Phone:888-653-1444
Mailing Address - Fax:888-653-1444
Practice Address - Street 1:2396 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3983
Practice Address - Country:US
Practice Address - Phone:888-653-1444
Practice Address - Fax:888-653-1444
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional