Individual provider Active NPI

Sean Michael Ronnau, LPC

  • Professional Counselor
  • Jacksonville, AR
National Provider Identifier
1093960411
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
P-1612187 Issued in AR
Practice address
625 N 1St St Ste C
Jacksonville, AR 72076-4138
Phone
(501) 985-0292
Fax
(501) 985-2070
NPI assigned
Nov 26, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Case Manager/Care Coordinator 171M00000X AR
Professional Counselor 101YP2500X P-1612187 AR Primary

Addresses

Primary practice location

625 N 1St St Ste C
Jacksonville, AR 72076-4138

Mailing address

116 W Hickory St
Jacksonville, AR 72076-4420
Phone (501) 985-0292

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
P-1612187ARMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Light Source Group LLC Current Accepting new patients
Northeast Arkansas Community Mental Health Center Inc Past Accepting new patients
Northeast Arkansas Community Mental Health Center Inc Past Accepting new patients

Locations

116 W Hickory St
Jacksonville, AR 72076

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1093960411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 W HICKORY ST",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720764420",
            "telephone_number": "501-985-0292",
            "fax_number": "501-985-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 N 1ST ST STE C",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720764138",
            "telephone_number": "501-985-0292",
            "fax_number": "501-985-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RONNAU",
        "first_name": "SEAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-26",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P-1612187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.