Provider Demographics
NPI:1841886173
Name:REGINA MEDART, LPC
Entity type:Organization
Organization Name:REGINA MEDART, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDART
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-350-9907
Mailing Address - Street 1:805 W 10TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2047
Mailing Address - Country:US
Mailing Address - Phone:512-350-9907
Mailing Address - Fax:512-531-9697
Practice Address - Street 1:805 W 10TH ST STE 302
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2047
Practice Address - Country:US
Practice Address - Phone:512-350-9907
Practice Address - Fax:512-531-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty