Provider Demographics
NPI:1013489277
Name:STEFANIE A. GRAY, PH.D.
Entity Type:Organization
Organization Name:STEFANIE A. GRAY, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-570-2454
Mailing Address - Street 1:132 PRINCESS PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5337
Mailing Address - Country:US
Mailing Address - Phone:210-570-2454
Mailing Address - Fax:210-966-8959
Practice Address - Street 1:132 PRINCESS PASS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5337
Practice Address - Country:US
Practice Address - Phone:210-570-2454
Practice Address - Fax:210-966-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14304738OtherCAQH ID