1255696423 NPI number — MARNI K WINKEL-REEVE M.A., LMFT, ATR-BC

Table of content: MARNI K WINKEL-REEVE M.A., LMFT, ATR-BC (NPI 1255696423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255696423 NPI number — MARNI K WINKEL-REEVE M.A., LMFT, ATR-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINKEL-REEVE
Provider First Name:
MARNI
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT, ATR-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINKEL
Provider Other First Name:
MARNI
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. LMFT, ATR-BC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1255696423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 OLD WILLOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVO
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84604-3649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-850-8673
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 E CENTER ST
Provider Second Line Business Practice Location Address:
SUITE #208
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84606-3156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-224-8255
Provider Business Practice Location Address Fax Number:
801-224-8301
Provider Enumeration Date:
07/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  7349851-3902 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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