Provider Demographics
NPI:1891479747
Name:GREY, JEREMY (CRM, PSS-AD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:GREY
Suffix:
Gender:M
Credentials:CRM, PSS-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 NE 54TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1948
Mailing Address - Country:US
Mailing Address - Phone:661-645-3751
Mailing Address - Fax:
Practice Address - Street 1:3004 NE 54TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1948
Practice Address - Country:US
Practice Address - Phone:661-645-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility