Healthcare Provider Details

I. General information

NPI: 1881403954
Provider Name (Legal Business Name): AJA GRAY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SOUTHFIELD DR
PLAINFIELD IN
46168-2464
US

IV. Provider business mailing address

620 8TH AVE
TERRE HAUTE IN
47804-2771
US

V. Phone/Fax

Practice location:
  • Phone: 317-837-9719
  • Fax: 317-458-1743
Mailing address:
  • Phone: 812-231-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005267A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: