Provider Demographics
NPI:1760670350
Name:GRAY, AMBER DENEEN (CHTVSP, CCFDVC, DBH)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DENEEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:CHTVSP, CCFDVC, DBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52997 CARROUSEL CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-7511
Mailing Address - Country:US
Mailing Address - Phone:951-382-4841
Mailing Address - Fax:
Practice Address - Street 1:GRAY'S TRAUMA-INFORMED CARE SERVICES CORP
Practice Address - Street 2:#1401
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530
Practice Address - Country:US
Practice Address - Phone:951-382-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN37-048-4108101YP2500X, 322D00000X, 251S00000X
CA28400101YA0400X, 103TF0200X
CA025255172V00000X, 174H00000X, 261QH0100X, 261QR1100X, 261QR1300X
CA251B00000X
CAN37-48-4108405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No251B00000XAgenciesCase Management
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28400OtherNATIONAL ASSOCIATION OF FORENSIC COUNSELORS
67040030471980OtherIOM4 PROFESSIONAL DEVELOPMENT CONSULTATION
CAN37-048-4108OtherNATIONAL ORGANIZATION FOR VICTIM ASSISTANCE