Provider Demographics
NPI:1477951788
Name:GRAY, GORDON HUNTER II (LISAC)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:HUNTER
Last Name:GRAY
Suffix:II
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 W THOMAS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3388
Mailing Address - Country:US
Mailing Address - Phone:480-804-0326
Mailing Address - Fax:602-368-8211
Practice Address - Street 1:9321 W THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3388
Practice Address - Country:US
Practice Address - Phone:480-804-0326
Practice Address - Fax:602-368-8211
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10039101YA0400X
AZLAC18061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)