Provider Demographics
NPI:1164533949
Name:ALCH, GREGORY SCOTT
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SCOTT
Last Name:ALCH
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 1:6550 YORK AVE S
Mailing Address - Street 2:SUITE 207
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2347
Mailing Address - Country:US
Mailing Address - Phone:952-926-6929
Mailing Address - Fax:952-922-0339
Practice Address - Street 1:6550 YORK AVE S
Practice Address - Street 2:SUITE 207
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2347
Practice Address - Country:US
Practice Address - Phone:952-926-6929
Practice Address - Fax:952-922-0339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist