Basic Information
Provider Information | |||||||||
NPI: | 1962478669 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GREGOIRE | ||||||||
FirstName: | DEEDEE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 301 UNIVERSITY BLVD | ||||||||
Address2: |   | ||||||||
City: | GALVESTON | ||||||||
State: | TX | ||||||||
PostalCode: | 775551385 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4097722166 | ||||||||
FaxNumber: | 4097722663 | ||||||||
Practice Location | |||||||||
Address1: | 301 UNIVERSITY BLVD | ||||||||
Address2: |   | ||||||||
City: | GALVESTON | ||||||||
State: | TX | ||||||||
PostalCode: | 77555 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4097722166 | ||||||||
FaxNumber: | 4097722663 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/23/2006 | ||||||||
LastUpdateDate: | 05/23/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 19918 | TX | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | GREGO-0003 | 01 | TX | COMPCARE | OTHER | 038924902 | 05 | TX |   | MEDICAID | 316877 | 01 | TX | MHN | OTHER | 788951000 | 01 | TX | MAGELLAN | OTHER | 0016RK | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |