Provider Demographics
NPI:1336349000
Name:GRAY, LARRY M (LMFT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:M
Last Name:GRAY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 TOBYLYNN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211
Mailing Address - Country:US
Mailing Address - Phone:615-305-5027
Mailing Address - Fax:615-833-6818
Practice Address - Street 1:6001 JACKSON SQUARE BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:LAVERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086
Practice Address - Country:US
Practice Address - Phone:615-305-5027
Practice Address - Fax:615-833-6818
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT0000000677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist