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General NPI Number Information
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NPI Number | 1891901914
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Entity Type | Individual
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Provider Name | ANNA GRAY MFT, PSYD.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 21 CHERRY ST
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City | PETALUMA
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State | CA
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Zip | 94952-2121
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Country | US
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Telephone | 141-530-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 21 CHERRY ST
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City | PETALUMA
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State | CA
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Zip | 94952-2121
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Country | US
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Telephone | 415-308-9999
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 40052
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY31257
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License Number State | CA
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