Provider Demographics
NPI:1497235659
Name:GRAY, AMBER SUE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:SUE
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:SUE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1952
Mailing Address - Country:US
Mailing Address - Phone:369-312-7006
Mailing Address - Fax:636-931-5304
Practice Address - Street 1:110 N MILL ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1816
Practice Address - Country:US
Practice Address - Phone:636-931-2700
Practice Address - Fax:636-931-5304
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health