Provider Demographics
NPI:1386526291
Name:GREGORY, KASSI (PHD, LP, LSSP)
Entity type:Individual
Prefix:DR
First Name:KASSI
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PHD, LP, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 10TH PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1909
Mailing Address - Country:US
Mailing Address - Phone:806-206-8028
Mailing Address - Fax:
Practice Address - Street 1:6202 IOLA AVE STE 133
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2729
Practice Address - Country:US
Practice Address - Phone:806-206-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty