Provider Demographics
NPI:1679276851
Name:KEYS, REGILYN TIAIRRA
Entity Type:Individual
Prefix:
First Name:REGILYN
Middle Name:TIAIRRA
Last Name:KEYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 ESTATE OFFICE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0614
Mailing Address - Country:US
Mailing Address - Phone:901-347-1145
Mailing Address - Fax:
Practice Address - Street 1:5395 ESTATE OFFICE DR STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0614
Practice Address - Country:US
Practice Address - Phone:901-232-1956
Practice Address - Fax:901-347-1145
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000006369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional