Provider Demographics
NPI:1649567959
Name:GRAY, JAMES WILLIAM III (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:GRAY
Suffix:III
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MAIN ST
Mailing Address - Street 2:STE. G
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1871
Mailing Address - Country:US
Mailing Address - Phone:208-750-3000
Mailing Address - Fax:208-750-1244
Practice Address - Street 1:621 MAIN ST
Practice Address - Street 2:STE. G
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1871
Practice Address - Country:US
Practice Address - Phone:208-750-3000
Practice Address - Fax:208-750-1244
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806162000Medicaid