MEDICARE: GINGER L. GRAY LCSW

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	101Y00000X	Counselor	30734	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649212713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINGER L. GRAY LCSW

Provider Business Mailing Address
First Line	:	136 CREEK RUN
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-2301
Country	:	US
Telephone Number	:	210-573-5034
Fax Number	:	210-545-2504

Provider Business Practice Location Address
First Line	:	19115 FM 2252
Second Line	:	STE 12
City	:	SAN ANTONIO
State	:	TX
Zip	:	78266-2577
Country	:	US
Telephone Number	:	210-573-5034
Fax Number	:	210-545-2504

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/01/2012

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