MEDICARE: JENNIFER GREGORY LCSW

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	101YM0800X	Mental Health Counselor	62622	TX
2	1041C0700X	Clinical Social Worker	62622	TX

General Provider Information

NPI Number	:	1295339216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GREGORY LCSW

Provider Business Mailing Address
First Line	:	3334 SSW LOOP 323 STE 107
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-9237
Country	:	US
Telephone Number	:	903-330-1536
Fax Number	:	903-470-7328

Provider Business Practice Location Address
First Line	:	3334 SSW LOOP 323 STE 107
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-9237
Country	:	US
Telephone Number	:	903-330-1536
Fax Number	:	903-470-7328

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	01/22/2024

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Directions to “ JENNIFER GREGORY LCSW” Practice Location

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