Healthcare Provider Details

I. General information

NPI: 1073429064
Provider Name (Legal Business Name): JULIE GRAY LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 N PASTURE RD
WESTPORT CT
06880-2730
US

IV. Provider business mailing address

17 N PASTURE RD
WESTPORT CT
06880-2730
US

V. Phone/Fax

Practice location:
  • Phone: 818-429-6917
  • Fax:
Mailing address:
  • Phone: 818-429-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10117
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: