Provider Demographics
NPI:1316422439
Name:GREGG, NATASHA SUZANNE (LCPC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:SUZANNE
Last Name:GREGG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 EMPIRE LOOP
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2528
Mailing Address - Country:US
Mailing Address - Phone:360-220-3627
Mailing Address - Fax:
Practice Address - Street 1:725 6TH AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5005
Practice Address - Country:US
Practice Address - Phone:360-220-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-16101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional