MEDICARE: ALEXIS GREGORY

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	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor	11418	CA

General Provider Information

NPI Number	:	1558911487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS GREGORY

Provider Business Mailing Address
First Line	:	1309 SEPULVEDA BLVD APT 202
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-3459
Country	:	US
Telephone Number	:	901-921-1126
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 VINE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5250
Country	:	US
Telephone Number	:	310-526-7505
Fax Number	:

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

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	01/10/2024

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Directions to “ ALEXIS GREGORY ” Practice Location

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