Healthcare Provider Details

I. General information

NPI: 1619709136
Provider Name (Legal Business Name): ALLISON MARIE REGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 COURT ST STE 100
JACKSON CA
95642-2162
US

IV. Provider business mailing address

601 COURT ST STE 100
JACKSON CA
95642-2162
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-1244
  • Fax:
Mailing address:
  • Phone: 209-257-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: