Provider Demographics
NPI:1518525427
Name:GRAY, CLAIR MARIE
Entity Type:Individual
Prefix:
First Name:CLAIR
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 FORESTDALE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1646
Mailing Address - Country:US
Mailing Address - Phone:248-318-6898
Mailing Address - Fax:
Practice Address - Street 1:28000 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0960
Practice Address - Country:US
Practice Address - Phone:248-395-3777
Practice Address - Fax:248-395-3370
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty