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NPI Code Detail

MEDICARE: DR. STEVEN B GRESHAM MA, PHD

MEDICARE: DR. STEVEN B GRESHAM MA, PHD
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
1101YM0800XMental Health CounselorWA
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1285728972
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEVEN B GRESHAM MA, PHD
Provider Business Mailing Address
First Line : PO BOX 386
Second Line :
City : ARIVACA
State : AZ
Zip : 85601-0386
Country : US
Telephone Number : 360-472-1587
Fax Number :
Provider Business Practice Location Address
First Line : 39580 S LAGO DEL ORO PKWY
Second Line :
City : TUCSON
State : AZ
Zip : 85739-1091
Country : US
Telephone Number : 520-624-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 12/05/2022

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