MEDICARE: EBONY NICOLE GRAY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1942095252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY NICOLE GRAY

Provider Business Mailing Address
First Line	:	2655 E DEER SPRINGS WAY APT 1010
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1430
Country	:	US
Telephone Number	:	702-808-9504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 E DEER SPRINGS WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1407
Country	:	US
Telephone Number	:	702-808-9504
Fax Number	:

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

Provider Enumeration Date	:	04/09/2025
Last Update Date	:	05/08/2025

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Directions to “ EBONY NICOLE GRAY ” Practice Location

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