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General NPI Number Information
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NPI Number | 1285729731
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Entity Type | Individual
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Provider Name | WAYNE ALAN GREGORY PHD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 15035 BADGER RANCH BLVD
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City | WOODWAY
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State | TX
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Zip | 76712-8829
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Country | US
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Telephone | 254-776-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 FALL CREEK LOOP
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City | CEDAR PARK
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State | TX
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Zip | 78613-5817
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Country | US
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Telephone | 254-716-9301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 34661
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License Number State | TX
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