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NPI Code Detail

MEDICARE: ALLIE GREGG LPCC

MEDICARE: ALLIE GREGG LPCC
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
1101Y00000XCounselorCC02780MN
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1982101374
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLIE GREGG LPCC
Provider Business Mailing Address
First Line : 14301 EWING AVE S
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-4885
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1470 INDUSTRIAL DR NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-0700
Country : US
Telephone Number : 507-322-7752
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2018
Last Update Date : 03/23/2021

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