Provider Demographics
NPI:1093017048
Name:GRAY, BRENT ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 YAMATO RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8403
Mailing Address - Country:US
Mailing Address - Phone:561-241-9014
Mailing Address - Fax:561-994-2263
Practice Address - Street 1:2400 YAMATO RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8403
Practice Address - Country:US
Practice Address - Phone:561-241-9014
Practice Address - Fax:561-994-2263
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist