Provider Demographics
NPI:1669981676
Name:GREGG, ELIZABETH M (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:GREGG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:HURCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 S HIGH POINT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4926
Mailing Address - Country:US
Mailing Address - Phone:608-826-8010
Mailing Address - Fax:
Practice Address - Street 1:1170 N BIRD ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590
Practice Address - Country:US
Practice Address - Phone:608-834-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3150101YM0800X
WI6881125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health