Provider Demographics
NPI:1437250222
Name:GRAY, O. DANEL LOUIS (MSW, LCSW, DCSW)
Entity Type:Individual
Prefix:MR
First Name:O. DANEL
Middle Name:LOUIS
Last Name:GRAY
Suffix:
Gender:M
Credentials:MSW, LCSW, DCSW
Other - Prefix:MR
Other - First Name:ORONDE DANEL
Other - Middle Name:LOUIS
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW, DCSW
Mailing Address - Street 1:5801 SIR EDWARD LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7846
Mailing Address - Country:US
Mailing Address - Phone:314-741-5971
Mailing Address - Fax:314-741-5971
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:SOCIAL WORK DIVISION
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-289-6597
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0020541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO002054OtherCLINICAL SOCIAL WORK LICE