Provider Demographics
NPI:1992413314
Name:COONEY, GREGORY A
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:COONEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 SHILOH RD STE 9
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-2775
Mailing Address - Country:US
Mailing Address - Phone:855-593-4357
Mailing Address - Fax:
Practice Address - Street 1:149 SHILOH RD STE 9
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-2775
Practice Address - Country:US
Practice Address - Phone:855-593-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional