Healthcare Provider Details

I. General information

NPI: 1487995585
Provider Name (Legal Business Name): CASSONDRA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 OAKCREST DR
BATON ROUGE LA
70814-2587
US

IV. Provider business mailing address

3055 OAKCREST DR
BATON ROUGE LA
70814-2587
US

V. Phone/Fax

Practice location:
  • Phone: 409-356-3842
  • Fax:
Mailing address:
  • Phone: 409-356-3842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9945
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9945
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLC9945
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: