Provider Demographics
NPI:1417460437
Name:GAY, GREGORY DARCH (PLPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DARCH
Last Name:GAY
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 NE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5128
Mailing Address - Country:US
Mailing Address - Phone:816-255-6798
Mailing Address - Fax:
Practice Address - Street 1:6060 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-5130
Practice Address - Country:US
Practice Address - Phone:181-646-8668
Practice Address - Fax:816-468-6688
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012037395101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)