MEDICARE: GREG WESTERN AND ASSOCIATES PSYCHOTHERAPY, PC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1366020240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREG WESTERN AND ASSOCIATES PSYCHOTHERAPY, PC

Provider Business Mailing Address
First Line	:	5101 E LA PALMA AVE STE 100L
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-2056
Country	:	US
Telephone Number	:	714-420-7378
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 E LA PALMA AVE STE 100L
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-2056
Country	:	US
Telephone Number	:	714-420-7378
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY THOMAS WESTERN
Credential	:	PSY.D
Telephone Number	:	714-420-7378

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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