Healthcare Provider Details

I. General information

NPI: 1326443631
Provider Name (Legal Business Name): GRAY COUNSELING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 ARBOR ST STE 203
OMAHA NE
68144-2972
US

IV. Provider business mailing address

11620 ARBOR ST STE 203
OMAHA NE
68144-2972
US

V. Phone/Fax

Practice location:
  • Phone: 402-504-4924
  • Fax: 402-505-3754
Mailing address:
  • Phone: 402-504-4924
  • Fax: 402-505-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1227
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number443
License Number StateNE

VIII. Authorized Official

Name: MS. ANN E GRAY
Title or Position: THERAPIST/PRESIDENT
Credential: MA, LIMHP
Phone: 402-504-4924