Healthcare Provider Details

I. General information

NPI: 1942852017
Provider Name (Legal Business Name): MILES EUGENE GREGORY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 COHASSET RD STE 120
CHICO CA
95926-2282
US

IV. Provider business mailing address

260 COHASSET RD STE 120
CHICO CA
95926-2282
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-5933
  • Fax:
Mailing address:
  • Phone: 530-894-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT139339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: