Healthcare Provider Details

I. General information

NPI: 1124481510
Provider Name (Legal Business Name): LAYLA GRAY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAYLA URIBE MFT

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

IV. Provider business mailing address

988 HOWARD ST
SAN FRANCISCO CA
94103-4183
US

V. Phone/Fax

Practice location:
  • Phone: 77-784-8386
  • Fax:
Mailing address:
  • Phone: 415-975-0908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number68619
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: