Provider Demographics
NPI:1912452491
Name:REAGAN, SHAWN LEE (LPCI)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:LEE
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063-6153
Mailing Address - Country:US
Mailing Address - Phone:830-431-0724
Mailing Address - Fax:
Practice Address - Street 1:2121 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PIPE CREEK
Practice Address - State:TX
Practice Address - Zip Code:78063-6153
Practice Address - Country:US
Practice Address - Phone:830-431-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74242101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional