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General NPI Number Information
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NPI Number | 1720722069
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Entity Type | Individual
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Provider Name | GREGORY MOODY LAC
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Gender | Male
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 8079 N 85TH WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4321
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Country | US
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Telephone | 480-261-5015
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Fax |
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Provider Business Mailing Address
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Address Line | 5982 W TULSA ST
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City | CHANDLER
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State | AZ
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Zip | 85226-2713
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Country | US
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Telephone | 602-421-2340
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LAC-18841
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License Number State | AZ
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