MEDICARE: MRS. STEPHANIE SUZANNE GRAY M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063434546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE SUZANNE GRAY M.A.

Provider Business Mailing Address
First Line	:	4660 EL CAJON BLVD
Second Line	:	SUITE 210
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4450
Country	:	US
Telephone Number	:	619-640-3266
Fax Number	:	619-640-3269

Provider Business Practice Location Address
First Line	:	4660 EL CAJON BLVD
Second Line	:	SUITE 210
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4450
Country	:	US
Telephone Number	:	619-640-3266
Fax Number	:	619-640-3269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	04/01/2011

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