Healthcare Provider Details

I. General information

NPI: 1790367415
Provider Name (Legal Business Name): AMANDA PASLEY GRAY, LPC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SANDIA PLZ
BRYAN TX
77802-4356
US

IV. Provider business mailing address

1401 SANDIA PLZ
BRYAN TX
77802-4356
US

V. Phone/Fax

Practice location:
  • Phone: 512-650-9252
  • Fax:
Mailing address:
  • Phone: 512-650-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA PASLEY GRAY
Title or Position: PLLC
Credential: LPC
Phone: 512-650-9252