Provider Demographics
NPI:1891402491
Name:MINEAR, REGAN HALEY
Entity Type:Individual
Prefix:MS
First Name:REGAN
Middle Name:HALEY
Last Name:MINEAR
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 1:340 COMMERCE SQ
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3374
Mailing Address - Country:US
Mailing Address - Phone:219-879-3283
Mailing Address - Fax:219-879-6965
Practice Address - Street 1:340 COMMERCE SQ
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3374
Practice Address - Country:US
Practice Address - Phone:219-879-3283
Practice Address - Fax:219-879-6965
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009244A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33009244AOtherINSURANCE COMPANIES