MEDICARE: ADRIA SUSANNE GRAY BHWC

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	171400000X	Health & Wellness Coach	7803	OK
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1932937240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIA SUSANNE GRAY BHWC

Provider Business Mailing Address
First Line	:	PO BOX 60189
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73146-0189
Country	:	US
Telephone Number	:	918-636-3474
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 60189
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73146-0189
Country	:	US
Telephone Number	:	918-636-3474
Fax Number	:

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

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	08/21/2024

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