Provider Demographics
NPI:1972970846
Name:GRAY COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:GRAY COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY-DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-273-3050
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:KY
Mailing Address - Zip Code:42327-0654
Mailing Address - Country:US
Mailing Address - Phone:270-273-3050
Mailing Address - Fax:270-273-3052
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:KY
Practice Address - Zip Code:42327
Practice Address - Country:US
Practice Address - Phone:270-273-3050
Practice Address - Fax:270-273-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty