Provider Demographics
NPI:1063474831
Name:REASONER, SUSAN H (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:REASONER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EXECUTIVE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4487
Mailing Address - Country:US
Mailing Address - Phone:501-448-0060
Mailing Address - Fax:501-448-0066
Practice Address - Street 1:28 RAHLING CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9187
Practice Address - Country:US
Practice Address - Phone:501-448-0060
Practice Address - Fax:501-448-0066
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1105-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117612001Medicaid
AR117612001Medicaid
AR5T462Medicare ID - Type Unspecified