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General NPI Number Information
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NPI Number | 1386424182
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Entity Type | Individual
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Provider Name | BRYAN KENDELL GRAY
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Gender | Male
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 3960 BROADWAY BLVD STE 250
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City | GARLAND
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State | TX
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Zip | 75043-8345
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Country | US
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Telephone | 469-969-0422
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Fax |
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Provider Business Mailing Address
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Address Line | 4712 RIDGEDALE DR
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City | PLANO
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State | TX
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Zip | 75024-2434
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Country | US
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Telephone | 504-777-0125
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 92175
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License Number State | TX
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