Healthcare Provider Details

I. General information

NPI: 1700815065
Provider Name (Legal Business Name): REGINA LYNN SPENCER LCSW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA OLIVER CSW

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/07/2023
Certification Date: 08/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12340 JONES ROAD, STE 290
HOUSTON TX
77070
US

IV. Provider business mailing address

12340 JONES ROAD, STE 290
HOUSTON TX
77070
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 832-756-2749
  • Fax: 859-201-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3804
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4021
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number65087
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65087
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4021
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: