Provider Demographics
NPI:1497209191
Name:GREGORY, MICHELLE LEEANNE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEEANNE
Last Name:GREGORY
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 1:9483 YOKUM ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8906
Mailing Address - Country:US
Mailing Address - Phone:530-936-4301
Mailing Address - Fax:
Practice Address - Street 1:2585 CEANOTHUS AVE STE 170
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-8243
Practice Address - Country:US
Practice Address - Phone:530-830-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health