=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700936671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATJA MEANDA REGO L.M.H.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 06/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 NW 116TH AVE
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-255-5715
-----------------------------------------------------
Fax | 954-575-1315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9606
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33075-9606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-255-5715
-----------------------------------------------------
Fax | 954-575-1315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH-4491
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH4491
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------