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General NPI Number Information
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NPI Number | 1205216405
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Entity Type | Individual
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Provider Name | CARAJEAN GRAY LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 9850 W ST LUKES DR STE 320
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City | NAMPA
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State | ID
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Zip | 83687-7912
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Country | US
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Telephone | 208-505-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.014900
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006049
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-42761
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License Number State | ID
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