MEDICARE: MR. SEAN MICHAEL RONNAU LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		AR
2	101YP2500X	Professional Counselor	P-1612187	AR
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1093960411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN MICHAEL RONNAU LPC

Provider Business Mailing Address
First Line	:	625 N 1ST ST STE C
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4138
Country	:	US
Telephone Number	:	501-985-0292
Fax Number	:	501-985-2070

Provider Business Practice Location Address
First Line	:	625 N 1ST ST STE C
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4138
Country	:	US
Telephone Number	:	501-985-0292
Fax Number	:	501-985-2070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	11/18/2024

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