Active NPI
Jean Rene Reynolds, MSED, LPCC
- Professional Counselor
- Bemidji, MN
National Provider Identifier
1720143282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1774
- Practice address
- 519 Anne St NW Ste B
Bemidji, MN 56601-4278 - Phone
- (218) 444-2845
- Fax
- (218) 444-2847
- NPI assigned
- Dec 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1774 | MN | Primary |
Addresses
Primary practice location
519 Anne St NW Ste B
Bemidji, MN 56601-4278
Mailing address
PO Box 430
Bemidji, MN 56619-0430
Phone (218) 444-2845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1774 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523923200000",
"number": "1720143282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 430",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566190430",
"telephone_number": "218-444-2845",
"fax_number": "218-444-2847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "519 ANNE ST NW STE B",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566014278",
"telephone_number": "218-444-2845",
"fax_number": "218-444-2847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "JEAN",
"middle_name": "RENE",
"credential": "MSED, LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-26",
"last_updated": "2018-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "1774",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bemidji, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.