Provider Demographics
NPI:1245561851
Name:CARRELS, REGINA LYNNE (BS, PSRS)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LYNNE
Last Name:CARRELS
Suffix:
Gender:F
Credentials:BS, PSRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 S ELM PL STE B
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7950
Mailing Address - Country:US
Mailing Address - Phone:918-286-2535
Mailing Address - Fax:
Practice Address - Street 1:3100 S ELM PL STE B
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7950
Practice Address - Country:US
Practice Address - Phone:918-286-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health