Provider Demographics
NPI:1942306378
Name:REGAN LESTER- RODRIGUEZ, PHD, PC
Entity Type:Organization
Organization Name:REGAN LESTER- RODRIGUEZ, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-329-0881
Mailing Address - Street 1:PO BOX 163446
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-3446
Mailing Address - Country:US
Mailing Address - Phone:512-329-0881
Mailing Address - Fax:512-329-0876
Practice Address - Street 1:3530 BEE CAVE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5391
Practice Address - Country:US
Practice Address - Phone:512-329-0881
Practice Address - Fax:512-329-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26884103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7487002OtherAETNA NUMBER
TX0092NTOtherBC / BS NUMBER
TX0092NTOtherBC / BS NUMBER