Kimberly Diane Reagan, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

65334 Issued in TX

Practice address

107 Woodbine PL
Longview, TX 75601-2912

Phone

(800) 446-8253

Fax

(903) 234-1639

NPI assigned

Mar 17, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Sabine Valley Regional MHMR Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Longview, TX
  • NPI 1639232002

  Professional

  Medicare reassignment NPD
• Sabine Valley Regional MHMR Center

  • Family Medicine Physician
  • Longview, TX
  • NPI 1841835022
  NPD

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1356512495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WOODBINE PL",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756012912",
            "telephone_number": "800-446-8253",
            "fax_number": "903-234-1639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WOODBINE PL",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756012912",
            "telephone_number": "800-446-8253",
            "fax_number": "903-234-1639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAGAN",
        "first_name": "KIMBERLY",
        "middle_name": "DIANE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-17",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "65334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kareem Sharif Rasheed, MD
• Aatif Rashid, MD
• Kaye Butler Ratzlaff, LPC
• Fred Dee Rea, D.D.S.
• Karen Frazer Rea, D.D.S.
• William Roneu Reagan, D.D.S.
• Real Jobs for You, Inc.
• Rebound Pain Management & Rehabilitation, LLC
• John Michael Red Fox
• Rekha Reddy, M.D.

• Professional Counselor in Longview, TX
• Providers in Longview, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.