MEDICARE: NATALIE 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	101YP2500X	Professional Counselor	LPC-19703	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10221	OTHER	AZ	LICENSE NUMBER

General Provider Information

NPI Number	:	1417174665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE GREGORY LPC

Provider Business Mailing Address
First Line	:	1950 W HEATHERBRAE DR STE 4
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-5110
Country	:	US
Telephone Number	:	602-792-0019
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 W HEATHERBRAE DR STE 4
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-5110
Country	:	US
Telephone Number	:	602-792-0019
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	03/12/2021

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