Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TA0700X | Adult Development & Aging Psychologist | 7191 | OH |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 7191 | OH |
N | 103G00000X | Clinical Psychologist | 7191 | OH |
N | 103TC0700X | Clinical Psychologist | 7191 | OH |
N | 103TC1900X | Counseling Psychologist | 7191 | OH |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 7191 | OH |
N | 103TE1100X | Exercise & Sports Psychologist | 7191 | OH |
N | 103TF0000X | Family Psychologist | 7191 | OH |
N | 103TF0200X | Forensic Psychologist | 7191 | OH |
N | 103TH0004X | Health Psychologist | 7191 | OH |
N | 103TH0100X | Health Service | 7191 | OH |
NPI | 1881094480 |
---|---|
Provider Name | Dr. Jason Riebe |
First Address | Mentor, OH 44060-7276 |
Second Address | Independence, OH 44131-2159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2014 |
Last Update Date | 11/04/2019 |