Provider Demographics
NPI:1598036659
Name:THOMAS, GREGORY (PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2853
Mailing Address - Country:US
Mailing Address - Phone:407-538-0280
Mailing Address - Fax:
Practice Address - Street 1:410 N DILLARD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2853
Practice Address - Country:US
Practice Address - Phone:407-538-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health