Provider Demographics
NPI:1518497122
Name:MCCLOSKEY, REGGIE PINE (MFT)
Entity type:Individual
Prefix:
First Name:REGGIE
Middle Name:PINE
Last Name:MCCLOSKEY
Suffix:
Gender:X
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 KENNY RD STE 195
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2406
Mailing Address - Country:US
Mailing Address - Phone:614-957-0164
Mailing Address - Fax:614-417-5455
Practice Address - Street 1:2939 KENNY RD STE 195
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2406
Practice Address - Country:US
Practice Address - Phone:614-957-0164
Practice Address - Fax:614-417-5455
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
OHM.2300249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No176B00000XOther Service ProvidersMidwife