Provider Demographics
NPI:1255997557
Name:GREMINGER, ANDREW BRYAN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRYAN
Last Name:GREMINGER
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:PO BOX 51482
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:P.O. BOX 51482
Practice Address - Street 2:291 DEL AMO FASHION SQ
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2023-02-16
Deactivation Date:2021-07-06
Deactivation Code:
Reactivation Date:2022-09-27
Provider Licenses
StateLicense IDTaxonomies
CALMFT130738106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist