Provider Demographics
NPI:1780792176
Name:GREGORY, NANCY JEAN (MA, LPCC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JEAN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S. SOLANO
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001
Mailing Address - Country:US
Mailing Address - Phone:575-527-7900
Mailing Address - Fax:575-571-4872
Practice Address - Street 1:315 S. HUDSON ST. STE #6
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88062
Practice Address - Country:US
Practice Address - Phone:575-388-4412
Practice Address - Fax:575-534-1170
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0072291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid
NM43439004Medicaid