Provider Demographics
NPI:1184193179
Name:REAGAN, MAURA CRISTIN (MA, LMHCA, R-DMT)
Entity Type:Individual
Prefix:MS
First Name:MAURA
Middle Name:CRISTIN
Last Name:REAGAN
Suffix:
Gender:F
Credentials:MA, LMHCA, R-DMT
Other - Prefix:MS
Other - First Name:MAURA
Other - Middle Name:CRISTIN
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHCA, R-DMT
Mailing Address - Street 1:600 ELLIOTT AVE W APT 415
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4080
Mailing Address - Country:US
Mailing Address - Phone:847-284-0790
Mailing Address - Fax:
Practice Address - Street 1:2002 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3827
Practice Address - Country:US
Practice Address - Phone:800-682-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR-DMT-2346225600000X
WAMC60885895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist