Provider Demographics
NPI:1558576421
Name:REGETS, CHARLES MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:REGETS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:REGETS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1846 51ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-7105
Mailing Address - Country:US
Mailing Address - Phone:360-357-3532
Mailing Address - Fax:
Practice Address - Street 1:2411 PACIFIC AVE. SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-357-3532
Practice Address - Fax:360-754-9358
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA73081OtherLABOR AND INDUSTRIES
WAAB23784Medicare PIN