Provider Demographics
NPI:1225205958
Name:GRAY, MARCIE
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
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 1:861 S CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6854
Mailing Address - Country:US
Mailing Address - Phone:435-668-1388
Mailing Address - Fax:
Practice Address - Street 1:1086 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5277
Practice Address - Country:US
Practice Address - Phone:435-668-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)