Healthcare Provider Details

I. General information

NPI: 1366168254
Provider Name (Legal Business Name): REGAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 LOWELL RD
WINDHAM NH
03087-1812
US

IV. Provider business mailing address

74 LOWELL RD
WINDHAM NH
03087-1812
US

V. Phone/Fax

Practice location:
  • Phone: 401-373-5528
  • Fax:
Mailing address:
  • Phone: 401-373-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERYL REGAL
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: LCMHC
Phone: 401-373-5528