Provider Demographics
NPI:1629845342
Name:GRAY, JANE C (LPC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:C
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:C
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3300 DRUID WAY
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2926
Mailing Address - Country:US
Mailing Address - Phone:469-265-8758
Mailing Address - Fax:
Practice Address - Street 1:3020 BROADMOOR LN STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2705
Practice Address - Country:US
Practice Address - Phone:972-539-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional