MEDICARE: DR. MEGAN A GRAY PSY.D.

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	103TH0004X	Health Psychologist	PSY30742	CA
2	103TC0700X	Clinical Psychologist	PSY30742	CA

General Provider Information

NPI Number	:	1265082069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN A GRAY PSY.D.

Provider Business Mailing Address
First Line	:	19712 MACARTHUR BLVD STE 110
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-2407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N ROOSEVELT AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3621
Country	:	US
Telephone Number	:	760-459-7912
Fax Number	:

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

Provider Enumeration Date	:	09/13/2019
Last Update Date	:	02/24/2022

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