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NPI Code Detail

MEDICARE: JANELLE GRAY LPCC

MEDICARE: JANELLE GRAY LPCC
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
1101YP2500XProfessional Counselor00145MN

General Provider Information

NPI Number : 1578094793
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANELLE GRAY LPCC
Provider Business Mailing Address
First Line : 3499 LEXINGTON AVE N STE 100
Second Line :
City : SAINT PAUL
State : MN
Zip : 55126-7058
Country : US
Telephone Number : 651-486-4828
Fax Number :
Provider Business Practice Location Address
First Line : 3499 LEXINGTON AVE N STE 100
Second Line :
City : SAINT PAUL
State : MN
Zip : 55126-7058
Country : US
Telephone Number : 651-486-4828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2017
Last Update Date : 04/11/2018

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Directions to “ JANELLE GRAY LPCC” Practice Location

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