Provider Demographics
NPI:1497165377
Name:GRAY, JEFFREY WAYNE (IMFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:GRAY
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 STATE ROUTE 60
Mailing Address - Street 2:114
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8707
Mailing Address - Country:US
Mailing Address - Phone:419-289-4825
Mailing Address - Fax:
Practice Address - Street 1:1763 STATE ROUTE 60
Practice Address - Street 2:114
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8707
Practice Address - Country:US
Practice Address - Phone:419-289-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0000046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist