Provider Demographics
NPI:1063947158
Name:REGAN, CHRISTINA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CORNWELL DR
Mailing Address - Street 2:#214
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4518
Mailing Address - Country:US
Mailing Address - Phone:405-394-2505
Mailing Address - Fax:
Practice Address - Street 1:1000 CORNWELL DR
Practice Address - Street 2:#214
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4518
Practice Address - Country:US
Practice Address - Phone:405-394-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician