Provider Demographics
NPI:1891446795
Name:YARBROUGH, GREGORY (LPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:YARBROUGH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-0403
Mailing Address - Country:US
Mailing Address - Phone:928-632-8179
Mailing Address - Fax:
Practice Address - Street 1:1515 E CEDAR AVE STE E-2
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1646
Practice Address - Country:US
Practice Address - Phone:928-714-0010
Practice Address - Fax:928-714-0024
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20553101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor