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General NPI Number Information
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NPI Number | 1215600929
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Entity Type | Individual
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Provider Name | GENESIS GREY
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Gender | Female
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 1900 27TH AVE
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City | MISSOULA
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State | MT
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Zip | 59804-5152
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Country | US
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Telephone | 619-994-9068
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 27TH AVE
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City | MISSOULA
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State | MT
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Zip | 59804-5136
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Country | US
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Telephone | 619-994-9068
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | BBH-LCSW-LIC-72746
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SC61406356
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | CO18321
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License Number State | NC
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