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General NPI Number Information
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NPI Number | 1295784650
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Entity Type | Individual
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Provider Name | KRISTIE LYNN GRAY L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 205 STATE HIGHWAY P
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City | POTOSI
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State | MO
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Zip | 63664-8486
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Country | US
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Telephone | 573-760-6206
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Fax | 573-438-6656
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Provider Business Mailing Address
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Address Line | PO BOX 128 14363 HWY 21 S
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City | POTOSI
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State | MO
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Zip | 63664-0128
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Country | US
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Telephone | 573-756-7859
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Fax | 573-438-6656
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19224
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002581
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License Number State | MO
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