Provider Demographics
NPI:1902789480
Name:GITTIN, REAGHAN (LAC)
Entity type:Individual
Prefix:
First Name:REAGHAN
Middle Name:
Last Name:GITTIN
Suffix:
Gender:X
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4746
Mailing Address - Country:US
Mailing Address - Phone:281-300-6544
Mailing Address - Fax:
Practice Address - Street 1:6232 N 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1850
Practice Address - Country:US
Practice Address - Phone:281-300-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health