Provider Demographics
NPI:1285706481
Name:KANE, REGINA (MS LCPC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-1377
Mailing Address - Country:US
Mailing Address - Phone:406-388-1607
Mailing Address - Fax:
Practice Address - Street 1:129 VILLAGE DR STE 303
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3493
Practice Address - Country:US
Practice Address - Phone:406-388-1607
Practice Address - Fax:406-388-4958
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1175 LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000742150OtherBLUE CROSS BLUE SHIELD #
MT0256700Medicaid