Provider Demographics
NPI:1881723674
Name:MUMMA, GREGORY H (PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:H
Last Name:MUMMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3709 22ND PL UNIT C
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1333
Mailing Address - Country:US
Mailing Address - Phone:806-559-6480
Mailing Address - Fax:806-795-2315
Practice Address - Street 1:3709 22ND PL UNIT C
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1333
Practice Address - Country:US
Practice Address - Phone:806-559-6480
Practice Address - Fax:806-795-2315
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical