Healthcare Provider Details

I. General information

NPI: 1548430036
Provider Name (Legal Business Name): REGINA LYNN ARCHER BHCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W CHOCTAW AVE
EL RENO OK
73036
US

IV. Provider business mailing address

210 W CHOCTAW AVE
EL RENO OK
73036
US

V. Phone/Fax

Practice location:
  • Phone: 405-295-2205
  • Fax:
Mailing address:
  • Phone: 405-295-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number21046
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: