Provider Demographics
NPI:1629329388
Name:GRAYS, TOTUNDRA (PHD, LCSW, MPA)
Entity Type:Individual
Prefix:MS
First Name:TOTUNDRA
Middle Name:
Last Name:GRAYS
Suffix:
Gender:F
Credentials:PHD, LCSW, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411338
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-8338
Mailing Address - Country:US
Mailing Address - Phone:214-697-4269
Mailing Address - Fax:
Practice Address - Street 1:15800 SEAGOVILLE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75253-5703
Practice Address - Country:US
Practice Address - Phone:972-892-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1629329388Medicaid