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General NPI Number Information
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NPI Number | 1487900619
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Entity Type | Individual
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Provider Name | LESLIE MARIE GRAY LPC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 439 SW MICHIGAN ST
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City | LAKE CITY
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State | FL
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Zip | 32025-0440
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Country | US
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Telephone | 352-374-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 SW 13TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32608-4006
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Country | US
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Telephone | 352-374-5600
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2011021465
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2100
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH17037
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License Number State | FL
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