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General NPI Number Information
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NPI Number | 1740970177
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Entity Type | Individual
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Provider Name | ANITA LOUISE REAGAN LAC
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Gender | Female
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 4200 JENNY LIND RD STE C
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City | FORT SMITH
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State | AR
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Zip | 72901-7632
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Country | US
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Telephone | 479-561-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 3407 BLAKE RD
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City | VAN BUREN
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State | AR
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Zip | 72956-7476
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Country | US
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Telephone | 479-462-7984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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