Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1073922332 |
---|---|
Provider Name | Ms. Colette Simone Gregory |
First Address | Palo Alto, CA 94306-2512 |
Second Address | San Jose, CA 95126-4823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2014 |
Last Update Date | 11/08/2014 |