Provider Demographics
NPI:1164802898
Name:KEARNEY, RAGAN MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:RAGAN
Middle Name:MICHELLE
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:RAGAN
Other - Middle Name:MICHELLE
Other - Last Name:BARCLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:110 W BELL RD APT 272
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-7498
Mailing Address - Country:US
Mailing Address - Phone:630-303-7763
Mailing Address - Fax:
Practice Address - Street 1:690 E WARNER RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3056
Practice Address - Country:US
Practice Address - Phone:480-444-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional