Provider Demographics
NPI:1447081203
Name:BEAVER, REAGHAN M
Entity type:Individual
Prefix:
First Name:REAGHAN
Middle Name:M
Last Name:BEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12170 WASHINGTON CENTER PKWY APT 12308
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3866
Mailing Address - Country:US
Mailing Address - Phone:740-616-3421
Mailing Address - Fax:
Practice Address - Street 1:12170 WASHINGTON CENTER PKWY APT 12308
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3866
Practice Address - Country:US
Practice Address - Phone:740-616-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist