Provider Demographics
NPI:1942554944
Name:DALKE, GREGORY A (LPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:DALKE
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 1:416 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-2822
Mailing Address - Country:US
Mailing Address - Phone:903-465-6344
Mailing Address - Fax:903-465-5943
Practice Address - Street 1:416 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75021-2822
Practice Address - Country:US
Practice Address - Phone:903-465-6344
Practice Address - Fax:903-465-5943
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health