Healthcare Provider Details

I. General information

NPI: 1689811879
Provider Name (Legal Business Name): RHONDA GRAYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2009
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ERICKSON AVE UNIT 95A
SHADY COVE OR
97539-9758
US

IV. Provider business mailing address

95 ERICKSON AVE UNIT 95A
SHADY COVE OR
97539-9758
US

V. Phone/Fax

Practice location:
  • Phone: 541-630-4727
  • Fax:
Mailing address:
  • Phone: 541-630-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC10091
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: