Provider Demographics
NPI:1891409223
Name:ADAMS-GRAY, LEIA R (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LEIA
Middle Name:R
Last Name:ADAMS-GRAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N BENJAMIN LN STE 185
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9625
Mailing Address - Country:US
Mailing Address - Phone:682-401-9827
Mailing Address - Fax:208-322-1029
Practice Address - Street 1:1017 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5229
Practice Address - Country:US
Practice Address - Phone:682-401-9827
Practice Address - Fax:208-322-1029
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52215104100000X
ID43131104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID43131OtherIDAHO BOARD OF SOCIAL WORK EXAMINERS