Provider Demographics
NPI:1467155606
Name:HART, RAEGIN LYN (LPC)
Entity Type:Individual
Prefix:
First Name:RAEGIN
Middle Name:LYN
Last Name:HART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7656 DAISY PORT LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3730
Mailing Address - Country:US
Mailing Address - Phone:936-446-0426
Mailing Address - Fax:
Practice Address - Street 1:7656 DAISY PORT LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3730
Practice Address - Country:US
Practice Address - Phone:936-446-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional