MEDICARE: REGAN ELIZABETH GOMBERT LCDC-I

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	76089	TX

General Provider Information

NPI Number	:	1659230217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGAN ELIZABETH GOMBERT LCDC-I

Provider Business Mailing Address
First Line	:	27805 RALPH FAIR RD
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015-4873
Country	:	US
Telephone Number	:	830-388-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	27805 RALPH FAIR RD
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015-4873
Country	:	US
Telephone Number	:	830-388-8338
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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