Healthcare Provider Details

I. General information

NPI: 1487900619
Provider Name (Legal Business Name): LESLIE MARIE GRAY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 NW 27TH LN STE F
GAINESVILLE FL
32606-6600
US

IV. Provider business mailing address

4140 NW 27TH LN STE F
GAINESVILLE FL
32606-6600
US

V. Phone/Fax

Practice location:
  • Phone: 386-717-6134
  • Fax:
Mailing address:
  • Phone: 386-717-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2100
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2011021465
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: