Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003382482 |
---|---|
Provider Name | Seann Gregory |
First Address | Grants Pass, OR 97527-5700 |
Second Address | Grants Pass, OR 97527-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2018 |
Last Update Date | 23/10/2018 |