Healthcare Provider Details

I. General information

NPI: 1508149519
Provider Name (Legal Business Name): EMILY GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 REMICK AVE
SUN VALLEY CA
91352-2935
US

IV. Provider business mailing address

8707 REMICK AVE
SUN VALLEY CA
91352-2935
US

V. Phone/Fax

Practice location:
  • Phone: 562-706-0053
  • Fax:
Mailing address:
  • Phone: 562-706-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF72612
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: