Provider Demographics
NPI:1780028266
Name:GREGORY, GRETCHEN ANN (LMSW)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 WINROCK BLVD APT 232
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4346
Mailing Address - Country:US
Mailing Address - Phone:713-677-3077
Mailing Address - Fax:
Practice Address - Street 1:5411 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5928
Practice Address - Country:US
Practice Address - Phone:713-677-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15949171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator