Provider Demographics
NPI:1790914950
Name:GRAY, REBECCA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 HIGDON FERRY RD STE C-111
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6913
Mailing Address - Country:US
Mailing Address - Phone:501-881-3033
Mailing Address - Fax:817-332-6489
Practice Address - Street 1:1635 HIGDON FERRY RD STE C-111
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6913
Practice Address - Country:US
Practice Address - Phone:501-881-3033
Practice Address - Fax:817-332-6489
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63132101YP2500X
AR19-01P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional