MEDICARE: ERIC GREGORISCH MS, LMFT

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	MT1697	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT1697	OTHER	FL	MARRIAGE COUNSELOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033273651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC GREGORISCH MS, LMFT

Provider Business Mailing Address
First Line	:	3839 W KENNEDY BLVD
Second Line	:	SUITE ONE
City	:	TAMPA
State	:	FL
Zip	:	33609-2719
Country	:	US
Telephone Number	:	813-350-9490
Fax Number	:	813-877-3839

Provider Business Practice Location Address
First Line	:	3839 W KENNEDY BLVD
Second Line	:	SUITE ONE
City	:	TAMPA
State	:	FL
Zip	:	33609-2719
Country	:	US
Telephone Number	:	813-350-9490
Fax Number	:	813-877-3839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	05/02/2008

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