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General NPI Number Information
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NPI Number | 1720343338
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Entity Type | Organization
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Legal Business Name | DR. BETSY C. REGEZ LLC
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 740 PILGRIM PKWY STE 103
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City | ELM GROVE
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State | WI
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Zip | 53122-2067
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Country | US
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Telephone | 262-853-7123
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Fax |
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Provider Business Mailing Address
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Address Line | 740 PILGRIM PKWY STE 103
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City | ELM GROVE
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State | WI
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Zip | 53122-2067
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Country | US
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Telephone | 262-853-7123
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | BETSY REGEZ
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Credential | PSYD
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Telephone | 262-853-7123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2342-057
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License Number State | WI
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