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NPI Code Detail

MEDICARE: FANNICA GREY LMFT

MEDICARE: FANNICA GREY 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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1962127852
Entity Type Code : Individual
Provider Name (Legal Business Name) : FANNICA GREY LMFT
Provider Business Mailing Address
First Line : 905 JEFFERSON AVE STE 300
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-4740
Country : US
Telephone Number : 651-239-2966
Fax Number : 651-846-4656
Provider Business Practice Location Address
First Line : 905 JEFFERSON AVE STE 300
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-4740
Country : US
Telephone Number : 651-800-1225
Fax Number : 651-846-4656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2022
Last Update Date : 09/18/2025

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