Provider Demographics
NPI:1891219283
Name:REGAN, CASEY KENDALL
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:KENDALL
Last Name:REGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NE HOLLADAY ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2000
Mailing Address - Country:US
Mailing Address - Phone:503-279-0100
Mailing Address - Fax:
Practice Address - Street 1:650 NE HOLLADAY ST STE 1700
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2000
Practice Address - Country:US
Practice Address - Phone:503-279-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health