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NPI 1073823084

NPI 1073823084 : REGINA GALE CANSLER LMFT : KILLEEN, TX

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General NPI Number Information
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    NPI Number           |    1073823084
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    Entity Type          |    Individual 
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    Provider Name        |    REGINA GALE CANSLER LMFT
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    10/12/2010
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    Last Update Date     |    10/12/2010
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Provider Practice Location Address
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    Address Line         |    1010 W JASPER DR SUITE 9
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    City                 |    KILLEEN
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    State                |    TX
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    Zip                  |    76542-1331
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    Country              |    US
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    Telephone            |    254-519-1144
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    Fax                  |    254-519-1155
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Provider Business Mailing Address
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    Address Line         |    114 TALAVERA PKWY APT. 1017
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    City                 |    SAN ANTONIO
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    State                |    TX
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    Zip                  |    78232-1055
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    Country              |    US
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    Telephone            |    254-519-1144
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    Fax                  |    254-519-1155
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    106H00000X
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    Taxonomy Name        |    Marriage & Family Therapist
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    License Number       |    201391
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    License Number State |    TX
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