Provider Demographics
NPI:1265810170
Name:GIFFORD, REGINA KAY (LPC)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:KAY
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 ELLEN KAY DR
Mailing Address - Street 2:STE D
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6286
Mailing Address - Country:US
Mailing Address - Phone:740-382-3874
Mailing Address - Fax:740-382-2930
Practice Address - Street 1:1125 ELLEN KAY DR
Practice Address - Street 2:STE D
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6286
Practice Address - Country:US
Practice Address - Phone:740-382-3874
Practice Address - Fax:740-382-2930
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1300481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health