Healthcare Provider Details
I. General information
NPI: 1760670350
Provider Name (Legal Business Name): Gray's Trauma-Informed Care Services
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 10/09/2007
Last Update Date: 03/18/2011
Certification Date: Website: gettraumainformed.com
Specializations: Domestic Violence, Child Abuse, Professional, Personal and Provider Development, Victim Services, Patient Advocacy, Victim Advocacy, Advocacy, Non-Sworn Law Enforcement, Elder Abuse, Parenting Education, Parenting
Professional Associations: National Association of Forensic Counselors (NAFC), National Organization of Victim Assistance (NOVA), American Association of Healthcare and Administrative Management (AAHAM), Patient-Centered Primary Care Collaborative (PCPCC), Alliance of Professional Healthcare Advocates (APHA), International Association of Doctors of Behavioral Health (IADBH)
Deactivation Date:
Reactivation Date:
III. Provider practice location address
500 W. Graham Ave. #1401 Gray's Trauma-Informed Care Services
Lake Elsinore CA
92530
US
IV. Provider business mailing address
500 W. Graham Ave. #1401 Gray's Trauma-Informed Care Services - Inquire Dept.
Lake Elsinore Ca
92530
US
V. Phone/Fax
- Phone: 951-382-4841
- Fax:
- Phone: 951-382-4841
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional |
| License Number | |
| License Number State | CA |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251B00000X |
| Taxonomy | Case Management |
| License Number | |
| License Number State | CA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251S00000X |
| Taxonomy | Community/Behavioral Health |
| License Number | |
| License Number State | CA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 322D00000X |
| Taxonomy | Residential Treatment Facility, Emotionally Disturbed Children |
| License Number | |
| License Number State | CA |
| # 6 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 174H00000X |
| License Number | |
| License Number State | CA |
| # 7 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 405300000X |
| License Number | |
| License Number State | CA |
| # 8 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 174400000X |
| License Number | |
| License Number State | CA |
| # 9 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 193200000X |
| License Number | |
| License Number State | CA |
| # 10 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 207Q00000X |
| License Number | |
| License Number State | CA |
| # 11 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 101YM0800X |
| License Number | |
| License Number State | CA |
| # 12 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 103TH0004X |
| License Number | |
| License Number State | CA |
| # 13 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 103TH0100X |
| License Number | |
| License Number State | CA |
| # 14 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 103TP0814X |
| License Number | |
| License Number State | CA |
| # 15 | |
| Primary Taxonomy | |
| Taxonomy Code | |
| Taxonomy | 103TW0100X |
| License Number | |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
