Provider Demographics
NPI:1770189094
Name:O'GWIN, REGINALD (LPC-A, LCDC)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:O'GWIN
Suffix:
Gender:M
Credentials:LPC-A, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 RUNNING DOE LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7237
Mailing Address - Country:US
Mailing Address - Phone:702-793-7220
Mailing Address - Fax:
Practice Address - Street 1:6400 E. HWY 290, BUILDING 3, SUITE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1032
Practice Address - Country:US
Practice Address - Phone:888-810-8272
Practice Address - Fax:888-316-1718
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82696101YP2500X
TX13700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13700OtherTEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES
TX82696OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS