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General NPI Number Information
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NPI Number | 1255040317
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Entity Type | Individual
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Provider Name | ANDREW ANTHONY GRAY
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Gender | Male
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 3707 E SHIELDS AVE
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City | FRESNO
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State | CA
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Zip | 93726-7029
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Country | US
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Telephone | 559-229-9041
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Fax |
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Provider Business Mailing Address
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Address Line | 4031 W NOBLE AVE
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City | VISALIA
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State | CA
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Zip | 93277-1631
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Country | US
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Telephone | 559-623-0101
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17356
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License Number State | CA
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