Provider Demographics
NPI:1952600181
Name:PRIMAS, GREGORY JEROME (MFT, LCDC-I)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JEROME
Last Name:PRIMAS
Suffix:
Gender:M
Credentials:MFT, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 SUNNY BEACH CT
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4406
Mailing Address - Country:US
Mailing Address - Phone:512-630-2374
Mailing Address - Fax:
Practice Address - Street 1:3803 SUNNY BEACH CT
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4406
Practice Address - Country:US
Practice Address - Phone:512-630-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7688101YA0400X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist