Provider Demographics
NPI:1720092950
Name:YOUSEY, GREGORY PETER (MA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:PETER
Last Name:YOUSEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N MAIN ST
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4376
Mailing Address - Country:US
Mailing Address - Phone:704-636-5522
Mailing Address - Fax:704-636-5533
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4376
Practice Address - Country:US
Practice Address - Phone:704-636-9550
Practice Address - Fax:704-636-5865
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2202103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107053Medicaid