Provider Demographics
NPI:1023478195
Name:HAYNIE, RAGAN (MA, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:RAGAN
Middle Name:
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 DALEY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:LA
Mailing Address - Zip Code:71067-9111
Mailing Address - Country:US
Mailing Address - Phone:318-510-4023
Mailing Address - Fax:
Practice Address - Street 1:3003 KNIGHT ST STE 115
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2561
Practice Address - Country:US
Practice Address - Phone:318-510-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLM 1246106H00000X
LAPLC 5945101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist