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General NPI Number Information
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NPI Number | 1558576421
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Entity Type | Individual
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Provider Name | CHARLES MICHAEL REGETS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 2411 PACIFIC AVE. SE
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City | OLYMPIA
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State | WA
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Zip | 98501
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Country | US
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Telephone | 360-357-3532
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Fax | 360-754-9358
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Provider Business Mailing Address
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Address Line | 1846 51ST AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98501-7105
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Country | US
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Telephone | 360-357-3532
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY00001572
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License Number State | WA
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