Provider Demographics
NPI:1225200801
Name:GRAY, LORRAINE (MS)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30721 RUSSELL RANCH RD STE 140
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-7383
Mailing Address - Country:US
Mailing Address - Phone:805-453-0618
Mailing Address - Fax:
Practice Address - Street 1:30721 RUSSELL RANCH RD STE 140
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-7383
Practice Address - Country:US
Practice Address - Phone:805-453-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist