Provider Demographics
NPI:1679656029
Name:HIETPAS, GREGORY P (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:P
Last Name:HIETPAS
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6953
Mailing Address - Country:US
Mailing Address - Phone:727-738-5054
Mailing Address - Fax:727-738-5054
Practice Address - Street 1:2430 ESTANCIA BLVD
Practice Address - Street 2:SUITE 101, OAK CREEK OFFICES
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2631
Practice Address - Country:US
Practice Address - Phone:727-738-5054
Practice Address - Fax:727-738-5054
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4491OtherBLUE CROSS BLUE SHIELD