Provider Demographics
NPI:1093960411
Name:RONNAU, SEAN MICHAEL (LPC)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:MICHAEL
Last Name:RONNAU
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N 1ST ST STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4138
Mailing Address - Country:US
Mailing Address - Phone:501-985-0292
Mailing Address - Fax:501-985-2070
Practice Address - Street 1:625 N 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4138
Practice Address - Country:US
Practice Address - Phone:501-985-0292
Practice Address - Fax:501-985-2070
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
ARP-1612187101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator