Healthcare Provider Details

I. General information

NPI: 1609497148
Provider Name (Legal Business Name): LEAH YVONNE GREGG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LEAH YVONNE HARGRAVES

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E KEN PRATT BLVD
LONGMONT CO
80504-5311
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 720-718-7000
  • Fax: 720-718-0900
Mailing address:
  • Phone: 970-624-2421
  • Fax: 970-490-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09926609
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: