MEDICARE: REGAN HOLLINGSWORTH BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1386150860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGAN HOLLINGSWORTH BCBA

Provider Business Mailing Address
First Line	:	2232 DRAKESTONE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2102
Country	:	US
Telephone Number	:	303-517-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 N CIRCLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2409
Country	:	US
Telephone Number	:	719-354-5297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	04/13/2023

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