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NPI Code Detail

MEDICARE: DR. LEE-ANNE GRAY PSYD

MEDICARE: DR. LEE-ANNE GRAY PSYD
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
1103TC0700XClinical PsychologistPSY19540CA

General Provider Information

NPI Number : 1912075425
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEE-ANNE GRAY PSYD
Provider Business Mailing Address
First Line : 20969 VENTURA BLVD
Second Line : SUITE 202
City : WOODLAND HILLS
State : CA
Zip : 91364-2305
Country : US
Telephone Number : 818-618-1382
Fax Number : 818-348-6988
Provider Business Practice Location Address
First Line : 20969 VENTURA BLVD
Second Line : SUITE 202
City : WOODLAND HILLS
State : CA
Zip : 91364-2305
Country : US
Telephone Number : 818-618-1382
Fax Number : 818-348-6988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 07/08/2007

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