Provider Demographics
NPI:1912377243
Name:RYE, REGINA R (MS, NCC, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:R
Last Name:RYE
Suffix:
Gender:F
Credentials:MS, NCC, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37776
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-7776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 TEXAS AVE UNIT 37776
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71133-5083
Practice Address - Country:US
Practice Address - Phone:318-709-9933
Practice Address - Fax:318-670-8683
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5000101YA0400X
LALAC-5097101YA0400X
LAPLC8349101YM0800X, 101YP2500X, 171M00000X
LA8349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator