Healthcare Provider Details

I. General information

NPI: 1134221435
Provider Name (Legal Business Name): REBECCA L GRAY LMHC, MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA L GRAY REBECCA HORNER

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 3RD ST NW FL 2
WINTER HAVEN FL
33881-4670
US

IV. Provider business mailing address

65 3RD ST NW FL 2
WINTER HAVEN FL
33881-4670
US

V. Phone/Fax

Practice location:
  • Phone: 863-223-3995
  • Fax: 863-251-8359
Mailing address:
  • Phone: 863-223-3995
  • Fax: 863-251-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14206884-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6618
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22927
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7508
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: