Provider Demographics
NPI:1487852240
Name:GREY, REGINALD DOUGLAS JR (ORDAINED PASTOR)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:DOUGLAS
Last Name:GREY
Suffix:JR
Gender:M
Credentials:ORDAINED PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3734
Mailing Address - Country:US
Mailing Address - Phone:559-477-9551
Mailing Address - Fax:
Practice Address - Street 1:847 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3734
Practice Address - Country:US
Practice Address - Phone:559-477-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100079AN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor