Provider Demographics
NPI:1205272069
Name:DUVALL, REGINA ELAINE
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ELAINE
Last Name:DUVALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35248 US HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-9115
Mailing Address - Country:US
Mailing Address - Phone:918-635-5482
Mailing Address - Fax:
Practice Address - Street 1:34183 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-9122
Practice Address - Country:US
Practice Address - Phone:918-649-7641
Practice Address - Fax:918-647-2926
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor