Provider Demographics
NPI:1699418475
Name:REGINO, KELLI (RBT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:REGINO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 GREEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1706
Mailing Address - Country:US
Mailing Address - Phone:817-560-1139
Mailing Address - Fax:817-560-7039
Practice Address - Street 1:2751 GREEN OAKS RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1706
Practice Address - Country:US
Practice Address - Phone:817-560-1139
Practice Address - Fax:817-560-7039
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-110266106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician