Provider Demographics
NPI:1205069077
Name:REGIS, TRACI H (MS, LPC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:H
Last Name:REGIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 FIELD CREST LN
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-1106
Mailing Address - Country:US
Mailing Address - Phone:612-424-9940
Mailing Address - Fax:
Practice Address - Street 1:4960 FIELD CREST LN
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-1106
Practice Address - Country:US
Practice Address - Phone:612-424-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15445-131101YA0400X
WI4464-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)