Provider Demographics
NPI:1740397587
Name:THAW, REGAN S (LCSW)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:S
Last Name:THAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 MAIN AVE
Mailing Address - Street 2:SUITE A105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5956
Mailing Address - Country:US
Mailing Address - Phone:970-259-2337
Mailing Address - Fax:970-259-2431
Practice Address - Street 1:2855 MAIN AVE
Practice Address - Street 2:SUITE A105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5956
Practice Address - Country:US
Practice Address - Phone:970-259-2337
Practice Address - Fax:970-259-2431
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO268OtherSTATE LICENSE