Provider Demographics
NPI:1508255431
Name:GRAY, RACHEL 'SHELLY' (MS, LMHP, PLADC, NCC)
Entity Type:Individual
Prefix:
First Name:RACHEL 'SHELLY'
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, LMHP, PLADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 OLD MILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2644
Mailing Address - Country:US
Mailing Address - Phone:402-312-8583
Mailing Address - Fax:
Practice Address - Street 1:10840 OLD MILL RD STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2644
Practice Address - Country:US
Practice Address - Phone:402-312-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1477101YA0400X
NE4930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)