Provider Demographics
NPI:1467593061
Name:GREGORY, PETER L (LMHC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:GREGORY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13043 CAMPBELL LN SE
Mailing Address - Street 2:
Mailing Address - City:TENINO
Mailing Address - State:WA
Mailing Address - Zip Code:98589-9253
Mailing Address - Country:US
Mailing Address - Phone:360-264-2082
Mailing Address - Fax:
Practice Address - Street 1:3624 ENSIGN ROAD
Practice Address - Street 2:SUITE 'F'
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-412-7950
Practice Address - Fax:360-412-7999
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health