Individual
AMANDA RAYBURN REAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-S, LISW-S
Contact information
Practice address
8170 JERRY DR, POWELL, OH 43065-6222
(713) 876-7990
Mailing address
8170 JERRY DR, POWELL, OH 43065-6222
(713) 876-7990
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
51487
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
282721401
TPI
TX
Enumeration date
05/12/2011
Last updated
09/13/2023
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