Provider Demographics
NPI:1659152379
Name:GREGG, JAYCE
Entity Type:Individual
Prefix:DR
First Name:JAYCE
Middle Name:
Last Name:GREGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 N SPRING APT 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-9605
Mailing Address - Country:US
Mailing Address - Phone:602-600-1265
Mailing Address - Fax:
Practice Address - Street 1:1861 N SPRING APT 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-9605
Practice Address - Country:US
Practice Address - Phone:602-600-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral