Provider Demographics
NPI:1972241644
Name:LUTHER, GREGORY ELLIOTT
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ELLIOTT
Last Name:LUTHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W ARTEMOS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1508
Mailing Address - Country:US
Mailing Address - Phone:406-218-1227
Mailing Address - Fax:
Practice Address - Street 1:1724 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7872
Practice Address - Country:US
Practice Address - Phone:406-214-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT63287101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor