MEDICARE: MR. GREGG ERVIN NATKOWSKI LPC, LLP, CAADC

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	103T00000X	Psychologist	6301006475	MI
2	101YP2500X	Professional Counselor	6401009245	MI

General Provider Information

NPI Number	:	1871564120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGG ERVIN NATKOWSKI LPC, LLP, CAADC

Provider Business Mailing Address
First Line	:	4764 WINDSWEPT DR
Second Line	:
City	:	MILFORD
State	:	MI
Zip	:	48380-2778
Country	:	US
Telephone Number	:	810-923-5760
Fax Number	:	810-225-0980

Provider Business Practice Location Address
First Line	:	800 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2303
Country	:	US
Telephone Number	:	810-923-5760
Fax Number	:	810-225-0980

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/12/2024

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