Healthcare Provider Details

I. General information

NPI: 1891446795
Provider Name (Legal Business Name): GREGORY YARBROUGH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E CEDAR AVE STE E-2
FLAGSTAFF AZ
86004-1646
US

IV. Provider business mailing address

PO BOX 403
DEWEY AZ
86327-0403
US

V. Phone/Fax

Practice location:
  • Phone: 928-714-0010
  • Fax: 928-714-0024
Mailing address:
  • Phone: 928-632-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-20553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: