Provider Demographics
NPI:1033253901
Name:AMMON, GREGORY ARTHUR (LPC MS NCC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ARTHUR
Last Name:AMMON
Suffix:
Gender:M
Credentials:LPC MS NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 MILWAUKEE ROAD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511
Mailing Address - Country:US
Mailing Address - Phone:608-364-1181
Mailing Address - Fax:
Practice Address - Street 1:1969 W HART ROAD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-364-5686
Practice Address - Fax:608-363-5756
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3191125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional