Provider Demographics
NPI:1700442076
Name:CULVER, REGINA LYNN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:LYNN
Last Name:CULVER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:L
Other - Last Name:CULVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1535 FARMERS LN # 235
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7525
Mailing Address - Country:US
Mailing Address - Phone:707-331-7130
Mailing Address - Fax:
Practice Address - Street 1:1260 N DUTTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-7121
Practice Address - Country:US
Practice Address - Phone:707-568-2300
Practice Address - Fax:707-568-2304
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99539101YM0800X, 106H00000X, 390200000X
CA126029101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700442076OtherNPI