Provider Demographics
NPI:1871564120
Name:NATKOWSKI, GREGG ERVIN (LPC, LLP, CAADC)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:ERVIN
Last Name:NATKOWSKI
Suffix:
Gender:M
Credentials:LPC, LLP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4764 WINDSWEPT DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48380-2778
Mailing Address - Country:US
Mailing Address - Phone:810-923-5760
Mailing Address - Fax:810-225-0980
Practice Address - Street 1:800 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2303
Practice Address - Country:US
Practice Address - Phone:810-923-5760
Practice Address - Fax:810-225-0980
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006475103T00000X
MI6401009245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist