Provider Demographics
NPI:1114160397
Name:KINNEAR, REAGAN LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:LYNN
Last Name:KINNEAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:LYNN
Other - Last Name:RINDERKNECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:134 EL CHICO TRL STE 105
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8862
Mailing Address - Country:US
Mailing Address - Phone:682-333-1533
Mailing Address - Fax:
Practice Address - Street 1:134 EL CHICO TRL STE 105
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8862
Practice Address - Country:US
Practice Address - Phone:682-333-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37167103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist