Provider Demographics
NPI:1922005313
Name:GRAY, YVONNE G (MSW)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:G
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7664 SLATE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8158
Mailing Address - Country:US
Mailing Address - Phone:614-860-0234
Mailing Address - Fax:614-860-0087
Practice Address - Street 1:7664 SLATE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8158
Practice Address - Country:US
Practice Address - Phone:614-860-0234
Practice Address - Fax:614-860-0087
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI5388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health