Provider Demographics
NPI:1669815866
Name:REAGH, STEPHINE DENISE (LPC)
Entity Type:Individual
Prefix:MS
First Name:STEPHINE
Middle Name:DENISE
Last Name:REAGH
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 1:3700 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9301
Mailing Address - Country:US
Mailing Address - Phone:903-736-3572
Mailing Address - Fax:
Practice Address - Street 1:3323 SSW LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9221
Practice Address - Country:US
Practice Address - Phone:903-525-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional