Provider Demographics
NPI:1326374836
Name:DAVIS, REGINA G (PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:G
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11703 HUEBNER RD
Mailing Address - Street 2:SUITE 106-147
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1201
Mailing Address - Country:US
Mailing Address - Phone:210-241-4954
Mailing Address - Fax:
Practice Address - Street 1:1100 NW LOOP 410
Practice Address - Street 2:STE 700
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2263
Practice Address - Country:US
Practice Address - Phone:210-241-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328721101Medicaid