Healthcare Provider Details

I. General information

NPI: 1386714970
Provider Name (Legal Business Name): REGIS PAUL HENSLEY MAED, PCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-5015
  • Fax: 330-543-4271
Mailing address:
  • Phone: 330-543-5015
  • Fax: 330-543-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0003802
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: