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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	6618	SC
3	101YP2500X	Professional Counselor	7508	NC
4	101YM0800X	Mental Health Counselor	MH22927	FL

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	:	238 N MASSACHUSETTS AVE FL 1
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4987
Country	:	US
Telephone Number	:	863-223-3995
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 N MASSACHUSETTS AVE FL 1
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4987
Country	:	US
Telephone Number	:	863-223-3995
Fax Number	:

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	01/17/2025

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