Provider Demographics
NPI:1366011934
Name:GREGORY, ROBERT TIMOTHY (LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TIMOTHY
Last Name:GREGORY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 TARNOW ST
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-6823
Mailing Address - Country:US
Mailing Address - Phone:517-428-9499
Mailing Address - Fax:
Practice Address - Street 1:1730 TARNOW ST
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48855-6823
Practice Address - Country:US
Practice Address - Phone:517-428-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01336106H00000X
MI4101007159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty