Provider Demographics
NPI:1598314361
Name:REGER, ANDREW LEE
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
Last Name:REGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 LAKE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5352
Mailing Address - Country:US
Mailing Address - Phone:260-225-8077
Mailing Address - Fax:
Practice Address - Street 1:2250 LAKE AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5352
Practice Address - Country:US
Practice Address - Phone:260-225-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health