Provider Demographics
NPI:1104257930
Name:MOSHER-RUDOLF, REGAN (LMHC)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:MOSHER-RUDOLF
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 HEARTLAND LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7671
Mailing Address - Country:US
Mailing Address - Phone:317-670-0311
Mailing Address - Fax:
Practice Address - Street 1:766 HEARTLAND LN
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7671
Practice Address - Country:US
Practice Address - Phone:317-670-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
39002160A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health