Provider Demographics
NPI:1821626987
Name:GREGORY, DENO LARRY (LAC, NCACI, SAP)
Entity Type:Individual
Prefix:
First Name:DENO
Middle Name:LARRY
Last Name:GREGORY
Suffix:
Gender:M
Credentials:LAC, NCACI, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 W 95TH ST STE 104-7
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3240
Mailing Address - Country:US
Mailing Address - Phone:913-514-4478
Mailing Address - Fax:
Practice Address - Street 1:8600 W 95TH ST STE 104-7
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3240
Practice Address - Country:US
Practice Address - Phone:913-514-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS901101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)