Provider Demographics
NPI:1598879124
Name:CARRILLO, REGINA (LPC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841398
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0077
Mailing Address - Country:US
Mailing Address - Phone:281-235-3010
Mailing Address - Fax:832-383-3471
Practice Address - Street 1:150 W SHADOWBEND AVE STE 200
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3970
Practice Address - Country:US
Practice Address - Phone:281-235-3010
Practice Address - Fax:832-383-2471
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional