MEDICARE: BRIDGET GRAY

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	101YP2500X	Professional Counselor	E.0701082	OH

General Provider Information

NPI Number	:	1295144731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET GRAY

Provider Business Mailing Address
First Line	:	15248 CENTER VILLAGE RD
Second Line	:
City	:	JOHNSTOWN
State	:	OH
Zip	:	43031-9216
Country	:	US
Telephone Number	:	614-230-4183
Fax Number	:

Provider Business Practice Location Address
First Line	:	7650 RIVERS EDGE DR # 203
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-1342
Country	:	US
Telephone Number	:	614-504-4466
Fax Number	:

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

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	04/01/2026

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