Provider Demographics
NPI:1700815065
Name:SPENCER, REGINA LYNN (LCSW-S)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:12340 JONES ROAD, STE 290
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:832-756-2749
Mailing Address - Fax:859-201-1151
Practice Address - Street 1:12340 JONES ROAD, STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3804104100000X
KY4021104100000X, 1041C0700X
TX65087104100000X, 1041C0700X
1041C0700X
KY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100396920Medicaid
TX394813501Medicaid