Provider Demographics
NPI:1164693487
Name:GRAY, MICHELE H
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:H
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 BONNIE BRAE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-3032
Mailing Address - Country:US
Mailing Address - Phone:317-313-9303
Mailing Address - Fax:
Practice Address - Street 1:4948 BONNIE BRAE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-3032
Practice Address - Country:US
Practice Address - Phone:317-313-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health