Provider Demographics
NPI:1669191037
Name:MANOLAS, REAGAN
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:MANOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:
Other - Last Name:CLINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19810 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5930
Mailing Address - Country:US
Mailing Address - Phone:907-932-1301
Mailing Address - Fax:907-290-8194
Practice Address - Street 1:19810 SCENIC DR
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5930
Practice Address - Country:US
Practice Address - Phone:907-932-1301
Practice Address - Fax:907-290-8194
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health