Healthcare Provider Details

I. General information

NPI: 1073858783
Provider Name (Legal Business Name): JEAN GRAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N LOOP 288
DENTON TX
76209-4887
US

IV. Provider business mailing address

306 N LOOP 288 STE 200
DENTON TX
76209-4958
US

V. Phone/Fax

Practice location:
  • Phone: 940-381-1501
  • Fax:
Mailing address:
  • Phone: 940-381-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69612
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: