Provider Demographics
NPI:1437383452
Name:GRAY, SCOTT MICHAEL
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 GRAND RIVER RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7333
Mailing Address - Country:US
Mailing Address - Phone:810-220-2787
Mailing Address - Fax:
Practice Address - Street 1:7600 GRAND RIVER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7333
Practice Address - Country:US
Practice Address - Phone:810-220-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009281101YM0800X, 103K00000X, 103TB0200X, 103TM1800X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation