Provider Demographics
NPI:1659032654
Name:GRAY, DANEILLE (MFT-I)
Entity Type:Individual
Prefix:
First Name:DANEILLE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 25TH ST NE APT 2122
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3979
Mailing Address - Country:US
Mailing Address - Phone:954-326-1707
Mailing Address - Fax:
Practice Address - Street 1:1510 STUART RD NE STE 107B
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5869
Practice Address - Country:US
Practice Address - Phone:423-464-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program