Provider Demographics
NPI:1093780173
Name:GRULEY, GREGORY B (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:B
Last Name:GRULEY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21751 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1846
Mailing Address - Country:US
Mailing Address - Phone:313-291-7000
Mailing Address - Fax:313-291-0942
Practice Address - Street 1:21751 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1846
Practice Address - Country:US
Practice Address - Phone:313-291-7000
Practice Address - Fax:313-291-0942
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional