Provider Demographics
NPI:1659538361
Name:CUELLAR-PROCTOR, REGINA E (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:E
Last Name:CUELLAR-PROCTOR
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 GERSHWIN DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4328
Mailing Address - Country:US
Mailing Address - Phone:920-391-4700
Mailing Address - Fax:920-391-4870
Practice Address - Street 1:3150 GERSHWIN DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4328
Practice Address - Country:US
Practice Address - Phone:920-391-4700
Practice Address - Fax:920-391-4870
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13990101YA0400X
WI6823-125101YM0800X
WI15632-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health