Provider Demographics
NPI:1306673330
Name:BURGENHEIM, REAGAN (LADAC II)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:BURGENHEIM
Suffix:
Gender:F
Credentials:LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 ORLEANS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2892
Mailing Address - Country:US
Mailing Address - Phone:615-281-9489
Mailing Address - Fax:
Practice Address - Street 1:2615 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2261
Practice Address - Country:US
Practice Address - Phone:615-893-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-14
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1670101YA0400X
TN487171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171100000XOther Service ProvidersAcupuncturist