Provider Demographics
NPI:1104196922
Name:GRAY, AMY L (LPCC-S)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 STONEWATER DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-1626
Mailing Address - Country:US
Mailing Address - Phone:330-705-5302
Mailing Address - Fax:
Practice Address - Street 1:524 W PARK AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-2580
Practice Address - Country:US
Practice Address - Phone:330-753-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health