Provider Demographics
NPI:1427186337
Name:GRAY, BOBBI J
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:J
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 1:108 RED BUD LN
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2945
Mailing Address - Country:US
Mailing Address - Phone:931-455-7455
Mailing Address - Fax:
Practice Address - Street 1:4618 OLD MANCHESTER HWY
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-6745
Practice Address - Country:US
Practice Address - Phone:931-393-3485
Practice Address - Fax:931-393-2342
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor