Provider Demographics
NPI:1720165343
Name:GRAY, DEE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 N MCCORMICK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2723
Mailing Address - Country:US
Mailing Address - Phone:928-778-4745
Mailing Address - Fax:
Practice Address - Street 1:143 N MCCORMICK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2723
Practice Address - Country:US
Practice Address - Phone:928-778-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW0396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CSW396IMedicare ID - Type Unspecified