Basic Information
Provider Information
NPI: 1558421073
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REGAL
FirstName: NEVA
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: PH.D. LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9615 E 148TH ST
Address2: SUITE 1
City: NOBLESVILLE
State: IN
PostalCode: 460604360
CountryCode: US
TelephoneNumber: 3175870500
FaxNumber:  
Practice Location
Address1: 17840 CUMBERLAND RD
Address2:  
City: NOBLESVILLE
State: IN
PostalCode: 460605409
CountryCode: US
TelephoneNumber: 3175741254
FaxNumber: 3176740060
Other Information
ProviderEnumerationDate: 12/12/2006
LastUpdateDate: 08/29/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X20042028AINN Behavioral Health & Social Service ProvidersPsychologist 
101YM0800X39001877AINY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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