Healthcare Provider Details

I. General information

NPI: 1093960411
Provider Name (Legal Business Name): SEAN MICHAEL RONNAU LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N 1ST ST STE C
JACKSONVILLE AR
72076-4138
US

IV. Provider business mailing address

116 W HICKORY ST
JACKSONVILLE AR
72076-4420
US

V. Phone/Fax

Practice location:
  • Phone: 501-985-0292
  • Fax: 501-985-2070
Mailing address:
  • Phone: 501-985-0292
  • Fax: 501-985-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP-1612187
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: