Provider Demographics
NPI:1356482012
Name:LERNER, GREGORY B (MHCA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:LERNER
Suffix:
Gender:M
Credentials:MHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 5TH ST
Mailing Address - Street 2:SUITE C #327
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4508
Mailing Address - Country:US
Mailing Address - Phone:360-722-0058
Mailing Address - Fax:
Practice Address - Street 1:5205 S 2ND AVE
Practice Address - Street 2:SUITE H
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-4114
Practice Address - Country:US
Practice Address - Phone:360-722-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
WAMC60170960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)