Provider Demographics
NPI:1922052091
Name:REENAN, STEVEN EDWIN (LPC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EDWIN
Last Name:REENAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:IBERIA
Mailing Address - State:MO
Mailing Address - Zip Code:65486-8242
Mailing Address - Country:US
Mailing Address - Phone:573-793-2162
Mailing Address - Fax:573-793-2162
Practice Address - Street 1:986 HIGHWAY A
Practice Address - Street 2:
Practice Address - City:IBERIA
Practice Address - State:MO
Practice Address - Zip Code:65486-8242
Practice Address - Country:US
Practice Address - Phone:573-793-2162
Practice Address - Fax:573-793-2162
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-21
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS 001374101YP2500X
MO2012004610363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional