Provider Demographics
NPI:1376909812
Name:GREY, LORISE (PHD, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LORISE
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41818 BROWNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-4802
Mailing Address - Country:US
Mailing Address - Phone:734-673-5420
Mailing Address - Fax:
Practice Address - Street 1:41818 BROWNSTONE DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-4802
Practice Address - Country:US
Practice Address - Phone:734-673-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI641010649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional