Healthcare Provider Details

I. General information

NPI: 1467384339
Provider Name (Legal Business Name): SEAN GREGORY M.S., PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PICCADILLY CIR
BOSSIER CITY LA
71111-7124
US

IV. Provider business mailing address

108 PICCADILLY CIR
BOSSIER CITY LA
71111-7124
US

V. Phone/Fax

Practice location:
  • Phone: 318-868-8767
  • Fax:
Mailing address:
  • Phone: 318-868-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11275
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: