Provider Demographics
NPI:1457549917
Name:GREGG, JENNY WINANS (MA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:WINANS
Last Name:GREGG
Suffix:
Gender:F
Credentials:MA
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 1108
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76503-1108
Mailing Address - Country:US
Mailing Address - Phone:785-979-8924
Mailing Address - Fax:254-773-0919
Practice Address - Street 1:3010 SCOTT BLVD
Practice Address - Street 2:STE. 103
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6800
Practice Address - Country:US
Practice Address - Phone:785-979-8924
Practice Address - Fax:254-773-0919
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health