Provider Demographics
NPI:1982955076
Name:BERRY, GREGORY (LMFT, CAS, PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:LMFT, CAS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80876
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-0876
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27405 PUERTA REAL
Practice Address - Street 2:150
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6314
Practice Address - Country:US
Practice Address - Phone:949-716-7833
Practice Address - Fax:949-716-7833
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAS - 3667101YA0400X
CAMFT 25330106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)