Provider Demographics
NPI:1720884067
Name:TEMPLE, GREGORY THOMAS (LCDC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:THOMAS
Last Name:TEMPLE
Suffix:
Gender:
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 E SONTERRA BLVD APT 1151
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-7653
Mailing Address - Country:US
Mailing Address - Phone:830-743-8338
Mailing Address - Fax:
Practice Address - Street 1:2015 NE LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5411
Practice Address - Country:US
Practice Address - Phone:210-291-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17202101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)