Provider Demographics
NPI:1225271935
Name:VOGT, GREGORY MAX (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MAX
Last Name:VOGT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 2532
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-1949
Mailing Address - Country:US
Mailing Address - Phone:530-575-6045
Mailing Address - Fax:
Practice Address - Street 1:18229 ROYAL PLUM
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-1949
Practice Address - Country:US
Practice Address - Phone:530-575-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13317103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical