=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629846944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALOREY GRAY LPCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2023
-----------------------------------------------------
Last Update Date | 12/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 S MORGAN ST
-----------------------------------------------------
City | MORGANFIELD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42437-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-285-9023
-----------------------------------------------------
Fax | 270-285-9037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 S MORGAN ST
-----------------------------------------------------
City | MORGANFIELD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42437-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-952-3114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 288431
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------