Individual
MR. TIMOTHY MARVIN GREGORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC, LPCC, CAMS-II
Contact information
Practice address
308 E 78TH ST, RICHFIELD, MN 55423-4315
(952) 956-3162
Mailing address
308 E 78TH ST, RICHFIELD, MN 55423-4315
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304316
MN
101YM0800X
Mental Health Counselor
Primary
2269
MN
Other
Enumeration date
02/10/2020
Last updated
02/10/2020
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