Provider Demographics
NPI:1639516396
Name:GAMAGE, REGINA (MS LMHC)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:GAMAGE
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:GAMAGE BASHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12521 NE 152ND AVE
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-7287
Mailing Address - Country:US
Mailing Address - Phone:360-254-9798
Mailing Address - Fax:
Practice Address - Street 1:12521 NE 152ND AVE
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-7287
Practice Address - Country:US
Practice Address - Phone:360-254-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health