Basic Information
| Provider Information | |||||||||
| NPI: | 1255561700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REIMERS | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.S. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 15 DECLARATION DR | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959734902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308934784 | ||||||||
| FaxNumber: | 5308936144 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 DECLARATION DR | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959734902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308934784 | ||||||||
| FaxNumber: | 5308936144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2009 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.