Provider Demographics
NPI:1417356577
Name:GRAY, SUZANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0750
Mailing Address - Country:US
Mailing Address - Phone:417-540-6221
Mailing Address - Fax:888-977-3363
Practice Address - Street 1:1530 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-626-0212
Practice Address - Fax:888-977-3363
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170255031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical