Provider Demographics
NPI:1407155765
Name:UNTERBERGER, GREGG RUSSELL (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:RUSSELL
Last Name:UNTERBERGER
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 NORTHLAND DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4961
Mailing Address - Country:US
Mailing Address - Phone:512-451-9527
Mailing Address - Fax:
Practice Address - Street 1:3305 NORTHLAND DR
Practice Address - Street 2:SUITE 206
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4961
Practice Address - Country:US
Practice Address - Phone:512-451-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional