Provider Demographics
NPI:1790546711
Name:F. GREG LLC
Entity Type:Organization
Organization Name:F. GREG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-226-7301
Mailing Address - Street 1:155 E CAPITOL DR STE 6A
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2143
Mailing Address - Country:US
Mailing Address - Phone:262-226-7301
Mailing Address - Fax:262-367-3828
Practice Address - Street 1:155 E CAPITOL DR STE 6A
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2143
Practice Address - Country:US
Practice Address - Phone:262-226-7301
Practice Address - Fax:262-367-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty