Healthcare Provider Details

I. General information

NPI: 1760123483
Provider Name (Legal Business Name): GRAYCOLORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/06/2023
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10835 SANTA MONICA BLVD STE 100
LOS ANGELES CA
90025-4691
US

IV. Provider business mailing address

3657 W CHAPMAN LN
INGLEWOOD CA
90305-2300
US

V. Phone/Fax

Practice location:
  • Phone: 310-418-7285
  • Fax:
Mailing address:
  • Phone: 310-418-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIKEA RENEE GRAY
Title or Position: OWNER
Credential: BCBA
Phone: 310-418-7285