Individual
MARY KATE REGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
149 S MAIN ST, PHOENIX, OR 97535-6631
(541) 535-4133
Mailing address
149 S MAIN ST, PHOENIX, OR 97535-6631
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OR
101Y00000X
Counselor
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/09/2019
Last updated
07/08/2020
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