Provider Demographics
NPI:1477198299
Name:KAISER, REGINA DESHAE (LMSW, CDP)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:DESHAE
Last Name:KAISER
Suffix:
Gender:F
Credentials:LMSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 SABINE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2840
Mailing Address - Country:US
Mailing Address - Phone:903-224-5816
Mailing Address - Fax:903-307-5401
Practice Address - Street 1:3913 SABINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2840
Practice Address - Country:US
Practice Address - Phone:903-224-5816
Practice Address - Fax:903-307-5401
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65200171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1598395352Medicaid