Provider Demographics
NPI:1912411661
Name:GRAY, EDWARD ALFRED (EDD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALFRED
Last Name:GRAY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 FOREST CHASE DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3573
Mailing Address - Country:US
Mailing Address - Phone:901-758-9015
Mailing Address - Fax:901-761-1358
Practice Address - Street 1:1000 CHERRY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5424
Practice Address - Country:US
Practice Address - Phone:901-681-9200
Practice Address - Fax:901-761-1358
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2691101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional