MEDICARE: TRICIA REGENTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor	6401018590	MI
3	101YP2500X	Professional Counselor	6401223011	MI

General Provider Information

NPI Number	:	1992323679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA REGENTIN

Provider Business Mailing Address
First Line	:	443 N STATE ST
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-1539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 W NEPESSING ST
Second Line	:
City	:	LAPEER
State	:	MI
Zip	:	48446-2090
Country	:	US
Telephone Number	:	989-672-6160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	05/24/2024

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Directions to “ TRICIA REGENTIN ” Practice Location

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