MEDICARE: JHATANYA HALL-GRAY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician
3	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1275165623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHATANYA HALL-GRAY

Provider Business Mailing Address
First Line	:	616 AZURE BANKS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1753
Country	:	US
Telephone Number	:	414-502-4664
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 AZURE BANKS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1753
Country	:	US
Telephone Number	:	414-502-4664
Fax Number	:

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

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	08/25/2021

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Directions to “ JHATANYA HALL-GRAY ” Practice Location

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