Healthcare Provider Details

I. General information

NPI: 1689600025
Provider Name (Legal Business Name): GREGORY R PALLAY LPC , LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 GREENWOOD RD
SHREVEPORT LA
71119-8413
US

IV. Provider business mailing address

6240 GREENWOOD RD
SHREVEPORT LA
71119-8413
US

V. Phone/Fax

Practice location:
  • Phone: 318-632-2010
  • Fax: 318-632-2055
Mailing address:
  • Phone: 318-632-2010
  • Fax: 318-632-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2557
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number172
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: