Provider Demographics
NPI:1194357004
Name:SPAYD, GREGORY MARK (LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MARK
Last Name:SPAYD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 GUADALUPE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3639
Mailing Address - Country:US
Mailing Address - Phone:361-244-2641
Mailing Address - Fax:
Practice Address - Street 1:4807 SPICEWOOD SPRINGS RD BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8444
Practice Address - Country:US
Practice Address - Phone:512-843-7665
Practice Address - Fax:512-444-7717
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty