MEDICARE: MR. SCOTT PAYSON GREGORY LMFT, ATR

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	181	CO

General Provider Information

NPI Number	:	1659388460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT PAYSON GREGORY LMFT, ATR

Provider Business Mailing Address
First Line	:	1115 ELKTON DR STE 403
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8507
Country	:	US
Telephone Number	:	719-574-6562
Fax Number	:	719-570-0386

Provider Business Practice Location Address
First Line	:	1115 ELKTON DR STE 403
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8507
Country	:	US
Telephone Number	:	719-574-6562
Fax Number	:	719-570-0386

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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