Provider Demographics
NPI:1346634086
Name:GRAY, JOHN MITCHELL (LPC-INTERN, LCDC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MITCHELL
Last Name:GRAY
Suffix:
Gender:M
Credentials:LPC-INTERN, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 RIDGEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2420
Mailing Address - Country:US
Mailing Address - Phone:682-583-1058
Mailing Address - Fax:
Practice Address - Street 1:3216 E 1ST ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-3831
Practice Address - Country:US
Practice Address - Phone:682-583-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73548101Y00000X
TX12809101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor