Healthcare Provider Details

I. General information

NPI: 1508587940
Provider Name (Legal Business Name): COZY GRAY LPC, M.ED, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PINE KNOLL DR APT 45
RIDGELAND MS
39157-1323
US

IV. Provider business mailing address

110 PINE KNOLL DR APT 45
RIDGELAND MS
39157-1323
US

V. Phone/Fax

Practice location:
  • Phone: 601-473-2106
  • Fax:
Mailing address:
  • Phone: 662-351-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3382
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3382
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: