Healthcare Provider Details

I. General information

NPI: 1639339534
Provider Name (Legal Business Name): REAGAN FUNKHOUSER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S PROMENADE BLVD STE 202
ROGERS AR
72758-8609
US

IV. Provider business mailing address

1707 LINWOOD DR STE B
PARAGOULD AR
72450-5365
US

V. Phone/Fax

Practice location:
  • Phone: 479-408-4197
  • Fax: 888-977-2956
Mailing address:
  • Phone: 870-604-4455
  • Fax: 888-977-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1958-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: