Provider Demographics
NPI:1457937500
Name:BELL, REGINALD JEROME SR (LPC-IT)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:JEROME
Last Name:BELL
Suffix:SR
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 N SERVITE DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-6201
Mailing Address - Country:US
Mailing Address - Phone:414-534-9963
Mailing Address - Fax:
Practice Address - Street 1:8411 N SERVITE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-6201
Practice Address - Country:US
Practice Address - Phone:414-534-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3866226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI823365778Medicaid