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NPI Code Detail

MEDICARE: MRS. LAKEITHA GRAY LPC,NCC

MEDICARE: MRS. LAKEITHA GRAY LPC,NCC
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
1101YM0800XMental Health Counselor2690MS
2101YP2500XProfessional Counselor2690MS
3101YP2500XProfessional Counselor5477LA

General Provider Information

NPI Number : 1710334057
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAKEITHA GRAY LPC,NCC
Provider Business Mailing Address
First Line : 1901 MANHATTAN BLVD BLDG D
Second Line :
City : HARVEY
State : LA
Zip : 70058-3583
Country : US
Telephone Number : 504-905-3563
Fax Number : 504-353-9918
Provider Business Practice Location Address
First Line : 1901 MANHATTAN BLVD BLDG D
Second Line :
City : HARVEY
State : LA
Zip : 70058-3583
Country : US
Telephone Number : 504-905-3563
Fax Number : 504-353-9918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2016
Last Update Date : 10/08/2024

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