Provider Demographics
NPI:1609497148
Name:GREGG, LEAH YVONNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:YVONNE
Last Name:GREGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:YVONNE
Other - Last Name:HARGRAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2421
Mailing Address - Fax:970-490-4156
Practice Address - Street 1:1750 E KEN PRATT BLVD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:720-718-7000
Practice Address - Fax:720-718-0900
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099266091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical