Provider Demographics
NPI:1205259751
Name:O'ROURKE, REGAN (LMHC)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 HIGHWAY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-3632
Mailing Address - Country:US
Mailing Address - Phone:904-423-0017
Mailing Address - Fax:
Practice Address - Street 1:5215 HIGHWAY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3632
Practice Address - Country:US
Practice Address - Phone:904-423-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health