Provider Demographics
NPI:1740970177
Name:REAGAN, ANITA LOUISE (LAC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:LOUISE
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 BLAKE RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-7476
Mailing Address - Country:US
Mailing Address - Phone:479-462-7984
Mailing Address - Fax:
Practice Address - Street 1:4200 JENNY LIND RD STE C
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7632
Practice Address - Country:US
Practice Address - Phone:479-561-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health