Provider Demographics
NPI:1821396243
Name:AMBS, REGINA MARIA (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARIA
Last Name:AMBS
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-9724
Mailing Address - Country:US
Mailing Address - Phone:269-692-3182
Mailing Address - Fax:
Practice Address - Street 1:1387 E M 89
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-9301
Practice Address - Country:US
Practice Address - Phone:269-692-2100
Practice Address - Fax:269-692-2101
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010492101YP2500X, 101Y00000X
MI264767101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool