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General NPI Number Information
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NPI Number | 1972241644
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Entity Type | Individual
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Provider Name | MR. GREGORY ELLIOTT LUTHER
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Gender | Male
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 801 SHERWOOD ST
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City | MISSOULA
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State | MT
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Zip | 59802-2659
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Country | US
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Telephone | 406-201-9073
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Fax |
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Provider Business Mailing Address
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Address Line | 410 W ARTEMOS DR
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City | MISSOULA
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State | MT
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Zip | 59803-1508
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Country | US
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Telephone | 406-218-1227
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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 | 78542
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License Number State | MT
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