Provider Demographics
NPI:1790468270
Name:ZUFELT, REAGON (CIT)
Entity Type:Individual
Prefix:
First Name:REAGON
Middle Name:
Last Name:ZUFELT
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 NATCHITOCHES ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-3751
Mailing Address - Country:US
Mailing Address - Phone:318-855-8773
Mailing Address - Fax:
Practice Address - Street 1:1416 NATCHITOCHES ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-3751
Practice Address - Country:US
Practice Address - Phone:318-855-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5645171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator