Provider Demographics
NPI:1346475753
Name:GRAY, JANE SIMPSON (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:SIMPSON
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6400
Mailing Address - Country:US
Mailing Address - Phone:512-324-3315
Mailing Address - Fax:512-324-3314
Practice Address - Street 1:1600 W 38TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6400
Practice Address - Country:US
Practice Address - Phone:512-324-3315
Practice Address - Fax:512-324-3314
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34163103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88075AOtherBCBS
TX217415301Medicaid
TX88075AOtherBCBS