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General NPI Number Information
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NPI Number | 1194382762
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Entity Type | Organization
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Legal Business Name | AMY GRAY LLC
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 1100 FAIRY FALLS DR STE 4
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City | COSHOCTON
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State | OH
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Zip | 43812-2803
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Country | US
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Telephone | 740-722-9416
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Fax | 740-722-9418
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Provider Business Mailing Address
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Address Line | 1100 FAIRY FALLS DR STE 4
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City | COSHOCTON
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State | OH
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Zip | 43812-2803
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Country | US
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Telephone | 740-722-9416
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Fax | 740-722-9418
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | AMY GRAY
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Credential | LISW-S, LICDC-CS
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Telephone | 740-705-1543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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