Provider Demographics
NPI:1558077644
Name:URQUHART, GREGORY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:URQUHART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 CARPENTER RD SE STE 203
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7905
Mailing Address - Country:US
Mailing Address - Phone:360-878-9526
Mailing Address - Fax:
Practice Address - Street 1:2401 BRISTOL CT SW STE D101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6037
Practice Address - Country:US
Practice Address - Phone:360-878-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61368270103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling