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General NPI Number Information
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NPI Number | 1922052091
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Entity Type | Individual
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Provider Name | STEVEN EDWIN REENAN LPC
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Gender | Male
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Dates
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Enumeration Date | 05/21/2006
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 986 HIGHWAY A
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City | IBERIA
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State | MO
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Zip | 65486-8242
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Country | US
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Telephone | 573-793-2162
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Fax | 573-793-2162
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Provider Business Mailing Address
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Address Line | 986 HIGHWAY A
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City | IBERIA
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State | MO
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Zip | 65486-8242
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Country | US
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Telephone | 573-793-2162
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Fax | 573-793-2162
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CS 001374
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2012004610
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License Number State | MO
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