Provider Demographics
NPI:1467795229
Name:WING, REGINA LYNNE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:LYNNE
Last Name:WING
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 1:36212 S 4214 RD
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-5696
Mailing Address - Country:US
Mailing Address - Phone:918-707-0222
Mailing Address - Fax:
Practice Address - Street 1:36212 S 4214 RD
Practice Address - Street 2:
Practice Address - City:INOLA
Practice Address - State:OK
Practice Address - Zip Code:74036-5696
Practice Address - Country:US
Practice Address - Phone:918-707-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health