Provider Demographics
NPI:1720499106
Name:GRAY, JOHN TRENT (MA, LMHCA, CDP,)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TRENT
Last Name:GRAY
Suffix:
Gender:M
Credentials:MA, LMHCA, CDP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8733 GREENWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3661
Mailing Address - Country:US
Mailing Address - Phone:206-407-3333
Mailing Address - Fax:
Practice Address - Street 1:8733 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3661
Practice Address - Country:US
Practice Address - Phone:206-407-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60202770101YA0400X
WAMC60611300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)