Healthcare Provider Details

I. General information

NPI: 1598463663
Provider Name (Legal Business Name): GREGORY IIAMES MAPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 E SOUTHERN AVE
TEMPE AZ
85282
US

IV. Provider business mailing address

874 S VINE ST
CHANDLER AZ
85225-6820
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-4600
  • Fax:
Mailing address:
  • Phone: 602-743-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21800
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC21800
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: