Provider Demographics
NPI:1639919731
Name:WALKER, REGINA RENE (MS,LMHCA)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:RENE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS,LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47805-2702
Mailing Address - Country:US
Mailing Address - Phone:812-223-3318
Mailing Address - Fax:
Practice Address - Street 1:4325 N 13TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47805-2702
Practice Address - Country:US
Practice Address - Phone:812-223-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001674A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health