Provider Demographics
NPI:1639876824
Name:KOUNLAVONG, REGAN MARIS (MA, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:MARIS
Last Name:KOUNLAVONG
Suffix:
Gender:
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 NEW SALEM HWY APT E304
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4314
Mailing Address - Country:US
Mailing Address - Phone:931-247-5302
Mailing Address - Fax:
Practice Address - Street 1:208 UPTOWN SQ
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0573
Practice Address - Country:US
Practice Address - Phone:931-486-8670
Practice Address - Fax:615-796-6911
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional