Provider Demographics
NPI:1770855298
Name:GRAY, RONDA C (CRC, CMS-CHT)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:C
Last Name:GRAY
Suffix:
Gender:F
Credentials:CRC, CMS-CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 NW 122ND ST
Mailing Address - Street 2:STE. A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1956
Mailing Address - Country:US
Mailing Address - Phone:405-831-3963
Mailing Address - Fax:405-748-5507
Practice Address - Street 1:2919 NW 122ND ST
Practice Address - Street 2:STE. A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1956
Practice Address - Country:US
Practice Address - Phone:405-831-3963
Practice Address - Fax:405-748-5507
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16573101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor