Provider Demographics
NPI:1891832978
Name:COLE, GREGORY ALLAN (PHD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLAN
Last Name:COLE
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 1:833 N HIGHWAY 99W
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-472-5225
Mailing Address - Fax:503-472-5025
Practice Address - Street 1:833 N HIGHWAY 99W
Practice Address - Street 2:SUITE B
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-472-5225
Practice Address - Fax:503-472-5025
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist