MEDICARE: HEIDI E. GRAY LMFT

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	LMFT84787	CA
2	106H00000X	Marriage & Family Therapist	INTERN #63600

General Provider Information

NPI Number	:	1902106370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI E. GRAY LMFT

Provider Business Mailing Address
First Line	:	1733 H. STREET
Second Line	:	STUDIO 450 #588
City	:	BLAINE
State	:	WA
Zip	:	98230-7414
Country	:	US
Telephone Number	:	159-063-9394
Fax Number	:

Provider Business Practice Location Address
First Line	:	1829 MARKET ST STE 202
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-7414
Country	:	US
Telephone Number	:	415-906-3939
Fax Number	:

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

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	03/03/2022

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