Provider Demographics
NPI:1447758842
Name:SPIVEY, REGAN
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 NUTMEG DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-0101
Mailing Address - Country:US
Mailing Address - Phone:318-239-3862
Mailing Address - Fax:318-239-3867
Practice Address - Street 1:114 NUTMEG DR
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-0101
Practice Address - Country:US
Practice Address - Phone:318-239-3862
Practice Address - Fax:318-239-3867
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health