MEDICARE: MARY MONICA CLAIRE GRAY MFT

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	106H00000X	Marriage & Family Therapist	106468	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356571467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MONICA CLAIRE GRAY MFT

Provider Business Mailing Address
First Line	:	NUNN DRIVE, UC 440
Second Line	:	HEALTH COUNSELING AND STUDENT WELLNESS
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41099
Country	:	US
Telephone Number	:	859-572-5650
Fax Number	:	859-572-5615

Provider Business Practice Location Address
First Line	:	NUNN DRIVE, UC 440
Second Line	:	HEALTH COUNSELING AND STUDENT WELLNESS
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41099
Country	:	US
Telephone Number	:	859-572-5650
Fax Number	:	859-572-5615

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

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	07/05/2016

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