Provider Demographics
NPI:1417638909
Name:GRAY, ALYSSA HAYLEE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:HAYLEE
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 1:2450 W
Mailing Address - Street 2:230TH PL
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:310-484-4280
Mailing Address - Fax:
Practice Address - Street 1:713 W COMMONWEALTH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832
Practice Address - Country:US
Practice Address - Phone:714-879-4274
Practice Address - Fax:714-879-2274
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician