Provider Demographics
NPI:1225436181
Name:GRAY, ZANIA NICOLE (AMFT)
Entity Type:Individual
Prefix:
First Name:ZANIA
Middle Name:NICOLE
Last Name:GRAY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:ZANIA
Other - Middle Name:NICOLE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 GREAT OAKS BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1314
Mailing Address - Country:US
Mailing Address - Phone:408-281-0708
Mailing Address - Fax:408-842-0893
Practice Address - Street 1:90 GREAT OAKS BLVD STE 108
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1314
Practice Address - Country:US
Practice Address - Phone:408-281-0708
Practice Address - Fax:408-842-0893
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAF1541204390200000X
CA100958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225436181Medicaid