Provider Demographics
NPI:1922370477
Name:GRAY, JANELLE MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3829
Mailing Address - Country:US
Mailing Address - Phone:847-608-2682
Mailing Address - Fax:
Practice Address - Street 1:474 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3829
Practice Address - Country:US
Practice Address - Phone:847-608-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health