Provider Demographics
NPI:1992701577
Name:AUSTIN, REGINA D (PHD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:D
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 KINGSTON PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3331
Mailing Address - Country:US
Mailing Address - Phone:865-264-2400
Mailing Address - Fax:865-886-4065
Practice Address - Street 1:2607 KINGSTON PIKE STE 250
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3331
Practice Address - Country:US
Practice Address - Phone:865-264-2400
Practice Address - Fax:865-886-4065
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32291103T00000X
TN2307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
86871AOtherBCBS
86871AOtherBCBS