Provider Demographics
NPI:1033236344
Name:GREGERSON, DANIEL L (LCPC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:GREGERSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MT
Mailing Address - Zip Code:59925-0935
Mailing Address - Country:US
Mailing Address - Phone:406-249-5611
Mailing Address - Fax:
Practice Address - Street 1:1860 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2627
Practice Address - Country:US
Practice Address - Phone:406-201-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT838-LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000251821Medicaid