Provider Demographics
NPI:1013420322
Name:FOX, REGINA RAE (LPC, CSAC)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:RAE
Last Name:FOX
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:RAE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, CSAC
Mailing Address - Street 1:300 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1639
Mailing Address - Country:US
Mailing Address - Phone:715-685-2200
Mailing Address - Fax:715-685-1185
Practice Address - Street 1:533 PEACE PIPE ROAD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-0189
Practice Address - Country:US
Practice Address - Phone:715-588-1511
Practice Address - Fax:715-588-3903
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15988101YA0400X
WI16333-132101YA0400X
WI5036-226101YP2500X
WI10655-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1013420322Medicaid