Provider Demographics
NPI:1497168413
Name:GRAY, PATRICK LAFAYETTE JR
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LAFAYETTE
Last Name:GRAY
Suffix:JR
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 1:4312 THOM BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2715
Mailing Address - Country:US
Mailing Address - Phone:702-541-3563
Mailing Address - Fax:
Practice Address - Street 1:5420 W SAHARA AVE STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0389
Practice Address - Country:US
Practice Address - Phone:702-541-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst