Provider Demographics
NPI:1235418757
Name:GRAY, JASMOND SHEREE
Entity Type:Individual
Prefix:
First Name:JASMOND
Middle Name:SHEREE
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 1:731 GLENWOOD SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7689
Mailing Address - Country:US
Mailing Address - Phone:702-806-3461
Mailing Address - Fax:
Practice Address - Street 1:731 GLENWOOD SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7689
Practice Address - Country:US
Practice Address - Phone:702-806-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor