Provider Demographics
NPI:1588858633
Name:STYLES, GREGORY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LYNN
Last Name:STYLES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 REDTAIL CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8605
Mailing Address - Country:US
Mailing Address - Phone:303-485-9529
Mailing Address - Fax:
Practice Address - Street 1:1520 REDTAIL CT
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8605
Practice Address - Country:US
Practice Address - Phone:303-485-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9926031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical