Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301002880 | MI |
NPI | 1003965740 |
---|---|
Provider Name | John T Regan |
First Address | Bruce, MI 48065-1015 |
Second Address | Flint, MI 48503-2445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |