Provider Demographics
NPI:1003572819
Name:MOY, GREGORY EUGENE (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EUGENE
Last Name:MOY
Suffix:
Gender:M
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 RENTON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6819
Mailing Address - Country:US
Mailing Address - Phone:206-580-3723
Mailing Address - Fax:
Practice Address - Street 1:3730 RENTON AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6819
Practice Address - Country:US
Practice Address - Phone:206-580-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC2200X, 103TS0200X
WAPY61068382103TC2200X, 103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool