Healthcare Provider Details

I. General information

NPI: 1316422439
Provider Name (Legal Business Name): NATASHA SUZANNE GREGG LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 1ST ST E STE 203
POLSON MT
59860-2100
US

IV. Provider business mailing address

314 1ST ST E STE 203
POLSON MT
59860-2100
US

V. Phone/Fax

Practice location:
  • Phone: 360-220-3627
  • Fax:
Mailing address:
  • Phone: 360-220-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-16
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: