Provider Demographics
NPI:1225345911
Name:REAGAN, MONICA ANNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ANNE
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:MONICA
Other - Middle Name:ANNE
Other - Last Name:GAYLORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:402 SOUTH SILVER SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-7536
Mailing Address - Country:US
Mailing Address - Phone:573-334-1100
Mailing Address - Fax:573-651-4345
Practice Address - Street 1:402 S SILVER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7536
Practice Address - Country:US
Practice Address - Phone:573-334-1100
Practice Address - Fax:573-651-4345
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007024736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494319502Medicaid