MEDICARE: REGINA WALSVIG, MARRIAGE AND FAMILY THERAPY, INC.

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1962184200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINA WALSVIG, MARRIAGE AND FAMILY THERAPY, INC.

Provider Business Mailing Address
First Line	:	901 DOVE ST STE 150
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-3018
Country	:	US
Telephone Number	:	949-649-6066
Fax Number	:	949-276-3083

Provider Business Practice Location Address
First Line	:	901 DOVE ST STE 150
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-3018
Country	:	US
Telephone Number	:	949-649-6066
Fax Number	:	949-276-3083

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. REGINA MARIE WALSVIG
Credential	:	MS, LMFT
Telephone Number	:	949-307-8367

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	08/04/2023

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