Provider Demographics
NPI:1891161410
Name:GREY, SUZY (ART-BC, LPTA)
Entity Type:Individual
Prefix:DR
First Name:SUZY
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:ART-BC, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 RUSSELL RD STE 93
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1054
Mailing Address - Country:US
Mailing Address - Phone:270-384-1736
Mailing Address - Fax:270-384-1734
Practice Address - Street 1:933 RUSSELL RD STE 93
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1054
Practice Address - Country:US
Practice Address - Phone:270-384-1736
Practice Address - Fax:270-384-1734
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional