Provider Demographics
NPI:1326564956
Name:GREGERSEN, COLLETTE CARTER (LPC)
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:CARTER
Last Name:GREGERSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:COLLETTE
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:444 HOSPITAL WAY STE 477
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2744
Mailing Address - Country:US
Mailing Address - Phone:208-233-7832
Mailing Address - Fax:
Practice Address - Street 1:444 HOSPITAL WAY STE 477
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2744
Practice Address - Country:US
Practice Address - Phone:208-233-7832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional