Provider Demographics
NPI:1982037875
Name:GRAYSON, TRENNA
Entity Type:Individual
Prefix:
First Name:TRENNA
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 N MIDWEST BLVD
Mailing Address - Street 2:APT. 1
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3244
Mailing Address - Country:US
Mailing Address - Phone:405-203-8981
Mailing Address - Fax:
Practice Address - Street 1:1511 N MIDWEST BLVD
Practice Address - Street 2:APT. 1
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3244
Practice Address - Country:US
Practice Address - Phone:405-203-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker