MEDICARE: ERIC WILLIAM GREGORY M.A.

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
2	101YP2500X	Professional Counselor	2009014951	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2009014951	OTHER	MO	MO DIVISION OF PROFESSIONAL REGISTRATION

General Provider Information

NPI Number	:	1982867933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC WILLIAM GREGORY M.A.

Provider Business Mailing Address
First Line	:	1430 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2303
Country	:	US
Telephone Number	:	314-206-3726
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	:	314-330-9748
Fax Number	:

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	06/08/2022

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