Provider Demographics
NPI:1710142468
Name:GREGORI, CATHERINE E (LAC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:E
Last Name:GREGORI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:E
Other - Last Name:MYRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC, LAC
Mailing Address - Street 1:1737 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4040
Mailing Address - Country:US
Mailing Address - Phone:406-671-9016
Mailing Address - Fax:
Practice Address - Street 1:848 MAIN ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3358
Practice Address - Country:US
Practice Address - Phone:406-697-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1194101YA0400X
MT1577101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT36-3343886Medicaid