Provider Demographics
NPI:1023558202
Name:WHITESELL, REGAN (M ED)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:WHITESELL
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-1431
Mailing Address - Country:US
Mailing Address - Phone:610-863-8151
Mailing Address - Fax:
Practice Address - Street 1:16 S BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-1431
Practice Address - Country:US
Practice Address - Phone:610-863-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor