Provider Demographics
NPI:1386935096
Name:REGINA CARRILLO,LLC
Entity type:Organization
Organization Name:REGINA CARRILLO,LLC
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:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-235-3010
Mailing Address - Street 1:150 W SHADOWBEND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3970
Mailing Address - Country:US
Mailing Address - Phone:281-235-3010
Mailing Address - Fax:832-383-3471
Practice Address - Street 1:150 W SHADOWBEND AVE STE 200
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3970
Practice Address - Country:US
Practice Address - Phone:281-235-3010
Practice Address - Fax:832-383-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty