Provider Demographics
NPI:1760655260
Name:GRAY, GREGORY DAVID (MS, LMFT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:DAVID
Last Name:GRAY
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HANNON CRESCENT
Mailing Address - Street 2:
Mailing Address - City:HANNON
Mailing Address - State:ON
Mailing Address - Zip Code:L0R 1P0
Mailing Address - Country:CA
Mailing Address - Phone:905-692-6081
Mailing Address - Fax:
Practice Address - Street 1:105 HANNON CRESCENT
Practice Address - Street 2:
Practice Address - City:HANNON
Practice Address - State:ON
Practice Address - Zip Code:L0R 1P0
Practice Address - Country:CA
Practice Address - Phone:905-692-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28868101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health