MEDICARE: MRS. REBECCA L GRAY LMHC, MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	14206884-6004	UT
2	101YP2500X	Professional Counselor	6618	SC
3	101YM0800X	Mental Health Counselor
4	101YM0800X	Mental Health Counselor	MH22927	FL
5	101YP2500X	Professional Counselor	7508	NC

General Provider Information

NPI Number	:	1134221435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA L GRAY LMHC, MS, LPC

Provider Business Mailing Address
First Line	:	65 3RD ST NW FL 2
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4670
Country	:	US
Telephone Number	:	863-223-3995
Fax Number	:	863-251-8359

Provider Business Practice Location Address
First Line	:	65 3RD ST NW FL 2
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4670
Country	:	US
Telephone Number	:	863-223-3995
Fax Number	:	863-251-8359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	06/30/2026

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