Healthcare Provider Details

I. General information

NPI: 1982063020
Provider Name (Legal Business Name): WENDY GRAY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S IMPERIAL HWY
ANAHEIM CA
92807-3943
US

IV. Provider business mailing address

136 S IMPERIAL HWY
ANAHEIM CA
92807-3943
US

V. Phone/Fax

Practice location:
  • Phone: 714-485-5938
  • Fax:
Mailing address:
  • Phone: 714-485-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30329
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number30329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: