Provider Demographics
NPI:1457841140
Name:VARNADO, RAEGAN RUSHELLE
Entity Type:Individual
Prefix:
First Name:RAEGAN
Middle Name:RUSHELLE
Last Name:VARNADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GOLDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4116
Mailing Address - Country:US
Mailing Address - Phone:985-707-6960
Mailing Address - Fax:
Practice Address - Street 1:300 MARINERS PLAZA DR STE 301
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-6833
Practice Address - Country:US
Practice Address - Phone:985-951-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor