Provider Demographics
NPI:1700098993
Name:GRAY, GUS MICHAEL (CPSS)
Entity Type:Individual
Prefix:MR
First Name:GUS
Middle Name:MICHAEL
Last Name:GRAY
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VINCENT PLACE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2376
Mailing Address - Country:US
Mailing Address - Phone:803-276-8000
Mailing Address - Fax:803-276-6669
Practice Address - Street 1:2043 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2249
Practice Address - Country:US
Practice Address - Phone:803-276-8000
Practice Address - Fax:803-276-6669
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor