Provider Demographics
NPI:1467046144
Name:GREGG, MICHELLE GABRIELA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GABRIELA
Last Name:GREGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 W DONALD LN
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-8766
Mailing Address - Country:US
Mailing Address - Phone:775-304-9579
Mailing Address - Fax:
Practice Address - Street 1:310 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-2831
Practice Address - Country:US
Practice Address - Phone:775-623-8100
Practice Address - Fax:855-950-0002
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst