Provider Demographics
NPI:1902186711
Name:MEREDITH, GREGARY E (LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGARY
Middle Name:E
Last Name:MEREDITH
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 1234
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0156
Mailing Address - Country:US
Mailing Address - Phone:307-857-3111
Mailing Address - Fax:307-857-3848
Practice Address - Street 1:902 NORTH 8TH WEST STREET
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2332
Practice Address - Country:US
Practice Address - Phone:307-857-3111
Practice Address - Fax:307-857-3848
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWYOMING PPC #534101YP2500X
WYLPC-1322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional