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NPI Code Detail

MEDICARE: CASSONDRA GRAY

MEDICARE: CASSONDRA 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
1171M00000XCase Manager/Care CoordinatorPLC9945LA
2101YM0800XMental Health CounselorPLC9945LA
3101YP2500XProfessional CounselorLC9945LA

General Provider Information

NPI Number : 1487995585
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSONDRA GRAY
Provider Business Mailing Address
First Line : 3055 OAKCREST DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70814-2587
Country : US
Telephone Number : 409-356-3842
Fax Number :
Provider Business Practice Location Address
First Line : 3055 OAKCREST DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70814-2587
Country : US
Telephone Number : 409-356-3842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2013
Last Update Date : 01/28/2026

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Directions to “ CASSONDRA GRAY ” Practice Location

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