Provider Demographics
NPI:1922640036
Name:WINTERS, REAGEN MAURA
Entity Type:Individual
Prefix:
First Name:REAGEN
Middle Name:MAURA
Last Name:WINTERS
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 1:4500 N 32ND ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3397
Mailing Address - Country:US
Mailing Address - Phone:480-799-5079
Mailing Address - Fax:866-457-3293
Practice Address - Street 1:4500 N 32ND ST STE 201A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3397
Practice Address - Country:US
Practice Address - Phone:480-799-5079
Practice Address - Fax:866-457-3293
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician