Provider Demographics
NPI:1972265429
Name:GRAY, JAMAYLA MARIE (APCC)
Entity Type:Individual
Prefix:MS
First Name:JAMAYLA
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:MS
Other - First Name:JAMAYLA
Other - Middle Name:MARIE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APCC
Mailing Address - Street 1:PO BOX 950295
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91395-0295
Mailing Address - Country:US
Mailing Address - Phone:818-743-6865
Mailing Address - Fax:661-793-6877
Practice Address - Street 1:17900 HIAWATHA ST APT 219
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-4226
Practice Address - Country:US
Practice Address - Phone:818-743-6865
Practice Address - Fax:661-793-6877
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC6972101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA84-5142642OtherMEDICAL