MEDICARE: MRS. JAMIE LYNNE GREGORY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2003019050	MO

General Provider Information

NPI Number	:	1215943659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE LYNNE GREGORY LPC

Provider Business Mailing Address
First Line	:	3637 UTAH PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-4828
Country	:	US
Telephone Number	:	314-669-1320
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 UTAH PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-4828
Country	:	US
Telephone Number	:	314-669-1320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	11/19/2021

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