Provider Demographics
NPI:1639997695
Name:GRAY, MATTHEW RAMSAY (SUDPT CO61581787)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RAMSAY
Last Name:GRAY
Suffix:
Gender:M
Credentials:SUDPT CO61581787
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3954 BYRON AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2880
Mailing Address - Country:US
Mailing Address - Phone:360-820-8633
Mailing Address - Fax:
Practice Address - Street 1:4120 MERIDIAN ST STE 220
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5575
Practice Address - Country:US
Practice Address - Phone:360-903-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61581787101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)