Provider Demographics
NPI:1972010106
Name:EDGAR-GRAY COUNSELING, PLLC
Entity Type:Organization
Organization Name:EDGAR-GRAY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANFORD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-351-5020
Mailing Address - Street 1:2802 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9057
Mailing Address - Country:US
Mailing Address - Phone:870-351-5020
Mailing Address - Fax:870-382-3025
Practice Address - Street 1:2909 KING ST STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5322
Practice Address - Country:US
Practice Address - Phone:870-351-5020
Practice Address - Fax:870-382-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty