Healthcare Provider Details

I. General information

NPI: 1417460437
Provider Name (Legal Business Name): GREGORY DARCH GAY PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N OAK TRFY
KANSAS CITY MO
64118-5130
US

IV. Provider business mailing address

6151 NE VILLAGE LN
KANSAS CITY MO
64118-5128
US

V. Phone/Fax

Practice location:
  • Phone: 181-646-8668
  • Fax: 816-468-6688
Mailing address:
  • Phone: 816-255-6798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2012037395
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: