Provider Demographics
NPI:1689149569
Name:REAGAN, PAMELA (LPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-0150
Mailing Address - Country:US
Mailing Address - Phone:419-238-1695
Mailing Address - Fax:419-238-1007
Practice Address - Street 1:1229 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1877
Practice Address - Country:US
Practice Address - Phone:419-238-1695
Practice Address - Fax:419-238-1007
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801298101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0378056Medicaid