Provider Demographics
NPI:1164529111
Name:GRAY, DEANNE (MFT)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232732
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-2732
Mailing Address - Country:US
Mailing Address - Phone:760-805-3273
Mailing Address - Fax:760-692-0251
Practice Address - Street 1:7220 AVENIDA ENCINAS STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4660
Practice Address - Country:US
Practice Address - Phone:760-805-3273
Practice Address - Fax:760-692-0251
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38499106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA854286OtherMHN