Provider Demographics
NPI:1194941435
Name:STANTON GREGOR, LEA M (LCPC)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:M
Last Name:STANTON GREGOR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:M
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:TRUE NORTH COUNSELING & CONSULTATION, LLC
Mailing Address - City:PETERSBURG
Mailing Address - State:AK
Mailing Address - Zip Code:99833-2155
Mailing Address - Country:US
Mailing Address - Phone:907-650-7292
Mailing Address - Fax:
Practice Address - Street 1:15 12TH STREET
Practice Address - Street 2:SUITE 212/212A
Practice Address - City:PETERSBURG
Practice Address - State:AK
Practice Address - Zip Code:99833
Practice Address - Country:US
Practice Address - Phone:907-650-7292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1218101YP2500X
AK369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT742860OtherBLUE CROSS PROVIDER