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General NPI Number Information
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NPI Number | 1760670350
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Entity Type | Individual
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Provider Name | Gray's Trauma-Informed Care Services
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Gender | Female
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 500 W. Graham Ave. #1401 Gray's Trauma-Informed Care Services
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City | Lake Elsinore
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State | CA
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Zip | 92530
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Country | US
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Telephone | 951-382-4841
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W. Graham Ave. #1401 Gray's Trauma-Informed Care Services - Inquire Dept.
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City | Lake Elsinore
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State | Ca
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Zip | 92530
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Country | US
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Telephone | 951-382-4841
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder)
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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 | 101YP2500X
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Taxonomy Name | Professional
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health
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License Number |
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 322D00000X
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Taxonomy Name | Residential Treatment Facility, Emotionally Disturbed Children
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License Number |
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License Number State | CA
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Taxonomy #6
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Taxonomy Code |
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Taxonomy Name | 174H00000X
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License Number |
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License Number State | CA
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Taxonomy #7
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Taxonomy Code |
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Taxonomy Name | 405300000X
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License Number |
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License Number State | CA
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Taxonomy #8
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Taxonomy Code |
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Taxonomy Name | 174400000X
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License Number |
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License Number State | CA
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Taxonomy #9
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Taxonomy Code |
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Taxonomy Name | 193200000X
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License Number |
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License Number State | CA
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Taxonomy #10
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Taxonomy Code |
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Taxonomy Name | 207Q00000X
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License Number |
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License Number State | CA
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Taxonomy #11
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Taxonomy Code |
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Taxonomy Name | 101YM0800X
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License Number |
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License Number State | CA
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Taxonomy #12
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Taxonomy Code |
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Taxonomy Name | 103TH0004X
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License Number |
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License Number State | CA
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Taxonomy #13
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Taxonomy Code |
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Taxonomy Name | 103TH0100X
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License Number |
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License Number State | CA
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Taxonomy #14
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Taxonomy Code |
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Taxonomy Name | 103TP0814X
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License Number |
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License Number State | CA
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Taxonomy #15
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Taxonomy Code |
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Taxonomy Name | 103TW0100X
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License Number |
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License Number State | CA
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