Healthcare Provider Details

I. General information

NPI: 1881577005
Provider Name (Legal Business Name): BECCA GREGORY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11105 NE 14TH ST STE 103
VANCOUVER WA
98684-4309
US

IV. Provider business mailing address

13215 SE MILL PLAIN BLVD STE C8
VANCOUVER WA
98684-6999
US

V. Phone/Fax

Practice location:
  • Phone: 360-207-0247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BECCA J GREGORY
Title or Position: OWNER
Credential: LICSW
Phone: 360-207-0247