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General NPI Number Information
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NPI Number | 1760123483
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Entity Type | Organization
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Legal Business Name | GRAYCOLORS INC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 10835 SANTA MONICA BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90025-4691
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Country | US
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Telephone | 310-418-7285
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Fax |
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Provider Business Mailing Address
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Address Line | 3657 W CHAPMAN LN
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City | INGLEWOOD
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State | CA
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Zip | 90305-2300
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Country | US
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Telephone | 310-418-7285
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MIKEA RENEE GRAY
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Credential | BCBA
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Telephone | 310-418-7285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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