Provider Demographics
NPI:1639733520
Name:GRAY, RANDI SHURIEE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:SHURIEE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 E SOUTHERN AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2512
Mailing Address - Country:US
Mailing Address - Phone:480-553-7743
Mailing Address - Fax:
Practice Address - Street 1:3740 E SOUTHERN AVE STE 209
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2512
Practice Address - Country:US
Practice Address - Phone:480-553-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE