Provider Demographics
NPI:1619303583
Name:GRAY, CASSANDRA (LMFT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12730 TOWNEPARK WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2303
Mailing Address - Country:US
Mailing Address - Phone:502-254-9555
Mailing Address - Fax:502-254-9554
Practice Address - Street 1:12730 TOWNEPARK WAY
Practice Address - Street 2:201
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2303
Practice Address - Country:US
Practice Address - Phone:502-254-9555
Practice Address - Fax:502-254-9554
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165751101YA0400X
KY101YM0800X
KY273462106H00000X
KYADLAD00223215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist