Provider Demographics
NPI:1740566207
Name:GAY, JERALYN
Entity Type:Individual
Prefix:MS
First Name:JERALYN
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 HIDDEN RIVER PKWY
Mailing Address - Street 2:STE. 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-1035
Mailing Address - Country:US
Mailing Address - Phone:813-541-0087
Mailing Address - Fax:813-971-0180
Practice Address - Street 1:8875 HIDDEN RIVER PKWY
Practice Address - Street 2:STE. 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-1035
Practice Address - Country:US
Practice Address - Phone:813-541-0087
Practice Address - Fax:813-971-0180
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health