Healthcare Provider Details

I. General information

NPI: 1073823084
Provider Name (Legal Business Name): REGINA GALE CANSLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2010
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W JASPER DR SUITE 9
KILLEEN TX
76542-1331
US

IV. Provider business mailing address

114 TALAVERA PKWY APT. 1017
SAN ANTONIO TX
78232-1055
US

V. Phone/Fax

Practice location:
  • Phone: 254-519-1144
  • Fax: 254-519-1155
Mailing address:
  • Phone: 254-519-1144
  • Fax: 254-519-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number201391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: