Healthcare Provider Details

I. General information

NPI: 1972265429
Provider Name (Legal Business Name): JAMAYLA MARIE GRAY APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMAYLA MARIE WELCH LPCC

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21535 ROSCOE BLVD APT 127
CANOGA PARK CA
91304-4157
US

IV. Provider business mailing address

PO BOX 950295
MISSION HILLS CA
91395-0295
US

V. Phone/Fax

Practice location:
  • Phone: 818-743-6865
  • Fax: 661-793-6877
Mailing address:
  • Phone: 818-743-6865
  • Fax: 661-793-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC19851
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC6972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: