Provider Demographics
NPI:1942349568
Name:GREGORY, ROBERT RANDOLPH (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RANDOLPH
Last Name:GREGORY
Suffix:
Gender:M
Credentials:LPC-MHSP
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 5593
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37928-0593
Mailing Address - Country:US
Mailing Address - Phone:865-414-1848
Mailing Address - Fax:
Practice Address - Street 1:3214 TAZEWELL PIKE STE 206
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2580
Practice Address - Country:US
Practice Address - Phone:865-414-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC2553101YP2500X
TN2553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional