Provider Demographics
NPI:1811311699
Name:GRAY, VERONICA (MED)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13594 SLALOM WAY DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4489
Mailing Address - Country:US
Mailing Address - Phone:225-313-1316
Mailing Address - Fax:225-218-6537
Practice Address - Street 1:8946 INTERLINE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1913
Practice Address - Country:US
Practice Address - Phone:225-313-1316
Practice Address - Fax:225-218-6537
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3655101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3655OtherSTATE OF LOUISIANA LICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS