Provider Demographics
NPI:1700936671
Name:REGO, KATJA MEANDA (LMHC)
Entity type:Individual
Prefix:MS
First Name:KATJA
Middle Name:MEANDA
Last Name:REGO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9606
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33075-9606
Mailing Address - Country:US
Mailing Address - Phone:954-255-5715
Mailing Address - Fax:954-575-1315
Practice Address - Street 1:3030 NW 116TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3450
Practice Address - Country:US
Practice Address - Phone:954-255-5715
Practice Address - Fax:954-575-1315
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-4491101YM0800X
FLMH4491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health