MEDICARE: GREGORY THOMAS LALIBERTE ED.S, LPC

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
2	101YP2500X	Professional Counselor	62730	TX

General Provider Information

NPI Number	:	1790982551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY THOMAS LALIBERTE ED.S, LPC

Provider Business Mailing Address
First Line	:	1601 MAIN ST STE 211
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3230
Country	:	US
Telephone Number	:	832-847-4836
Fax Number	:	832-847-4852

Provider Business Practice Location Address
First Line	:	1601 MAIN ST STE 211
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3230
Country	:	US
Telephone Number	:	832-847-4836
Fax Number	:	832-847-4852

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	12/28/2020

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