Provider Demographics
NPI:1073748133
Name:MENDENHALL, REGINA L (LICSW LIMHP LMSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:L
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:LICSW LIMHP LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13961 POLK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4049
Mailing Address - Country:US
Mailing Address - Phone:402-926-4444
Mailing Address - Fax:402-393-8230
Practice Address - Street 1:13961 POLK ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-4049
Practice Address - Country:US
Practice Address - Phone:402-926-4444
Practice Address - Fax:402-393-8230
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2757101YM0800X
NE4276101YM0800X
IA1014961041C0700X
NE15151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082303526Medicaid