Healthcare Provider Details

I. General information

NPI: 1538315569
Provider Name (Legal Business Name): ANDREW GRAY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 N. 9TH STREET CHILD & FAMILY GUIDANCE CENTER
TACOMA WA
98406
US

IV. Provider business mailing address

6424 N. 9TH STREET CHILD & FAMILY GUIDANCE CENTER
TACOMA WA
98406
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-4484
  • Fax: 253-565-5823
Mailing address:
  • Phone: 253-565-4484
  • Fax: 253-565-5823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLF60007032
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60007032
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: