Provider Demographics
NPI:1841594595
Name:GRAY, KEITH B II
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:B
Last Name:GRAY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 S SANTA FE AVE
Mailing Address - Street 2:# E
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-8413
Mailing Address - Country:US
Mailing Address - Phone:405-605-5757
Mailing Address - Fax:405-605-5775
Practice Address - Street 1:8901 S SANTA FE AVE
Practice Address - Street 2:# E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8413
Practice Address - Country:US
Practice Address - Phone:405-605-5757
Practice Address - Fax:405-605-5775
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health