Provider Demographics
NPI:1457139743
Name:GRAY, TAYLOR ASHLEY (MA, LMHC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ASHLEY
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MOUNT HOOD RD APT 9
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7317
Mailing Address - Country:US
Mailing Address - Phone:860-808-9503
Mailing Address - Fax:
Practice Address - Street 1:109 OAK ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1493
Practice Address - Country:US
Practice Address - Phone:617-977-5372
Practice Address - Fax:617-458-8644
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health