Provider Demographics
NPI:1801429469
Name:GRAY, JEFF MICHAEL I (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:MICHAEL
Last Name:GRAY
Suffix:I
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:OREGON STATE HOSPITAL
Mailing Address - Street 2:2600 CENTER ST. NE
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:OREGON STATE HOSPITAL
Practice Address - Street 2:2600 CENTER STREET NE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-945-0963
Practice Address - Fax:503-373-1681
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR56181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical