Healthcare Provider Details

I. General information

NPI: 1124081757
Provider Name (Legal Business Name): GRGICH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BASIN SUITE 302
PAHRUMP NV
89060-4612
US

IV. Provider business mailing address

PO BOX 939
PAHRUMP NV
89041-0939
US

V. Phone/Fax

Practice location:
  • Phone: 775-751-1349
  • Fax: 775-727-5551
Mailing address:
  • Phone: 775-751-1349
  • Fax: 775-727-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0413
License Number StateNV

VIII. Authorized Official

Name: DR. BECKIE M GRGICH
Title or Position: PRESIDENT
Credential: PSYD
Phone: 775-751-1349