Provider Demographics
NPI:1649212713
Name:GRAY, GINGER L (LCSW)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CREEK RUN
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-2301
Mailing Address - Country:US
Mailing Address - Phone:210-573-5034
Mailing Address - Fax:210-545-2504
Practice Address - Street 1:19115 FM 2252
Practice Address - Street 2:STE 12
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78266-2577
Practice Address - Country:US
Practice Address - Phone:210-573-5034
Practice Address - Fax:210-545-2504
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30734101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1706079Medicaid
TX611316Medicare ID - Type Unspecified