Provider Demographics
NPI:1003226473
Name:GRAY, ERIN KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHLEEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:KATHLEEN
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1611 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2132
Mailing Address - Country:US
Mailing Address - Phone:208-610-6929
Mailing Address - Fax:208-263-7719
Practice Address - Street 1:801 PINE ST STE 2
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1682
Practice Address - Country:US
Practice Address - Phone:208-263-7716
Practice Address - Fax:208-263-7719
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5113101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional