Provider Demographics
NPI:1073839361
Name:REAGAN, JEANNE B (MED, LPC-S)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:B
Last Name:REAGAN
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 FRONTIER LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3239
Mailing Address - Country:US
Mailing Address - Phone:214-808-3234
Mailing Address - Fax:214-828-0847
Practice Address - Street 1:8222 DOUGLAS AVE
Practice Address - Street 2:SUITE 777
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5923
Practice Address - Country:US
Practice Address - Phone:214-808-3247
Practice Address - Fax:214-828-0847
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional