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NPI Code Detail

MEDICARE: JENNY GRAY M.A., LPC

MEDICARE: JENNY GRAY M.A., 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
1101YP2500XProfessional Counselor66229TX

General Provider Information

NPI Number : 1730508094
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY GRAY M.A., LPC
Provider Business Mailing Address
First Line : 4686 BRISTOL TRACE TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6947
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4686 BRISTOL TRACE TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6947
Country : US
Telephone Number : 817-301-4844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2014
Last Update Date : 04/15/2014

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