Provider Demographics
NPI:1265799944
Name:GRAY, MICHAEL RYAN (LMHCA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RYAN
Last Name:GRAY
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-0993
Mailing Address - Country:US
Mailing Address - Phone:253-882-7598
Mailing Address - Fax:
Practice Address - Street 1:14515 A ST S APT 103D
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-6943
Practice Address - Country:US
Practice Address - Phone:253-882-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60264218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health