Provider Demographics
NPI:1932148426
Name:CRAVENS, GAYLE MICHAEL (EDD)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:MICHAEL
Last Name:CRAVENS
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 1:731 HOLMES DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1303
Mailing Address - Country:US
Mailing Address - Phone:731-989-5102
Mailing Address - Fax:731-989-6679
Practice Address - Street 1:367B N PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2899
Practice Address - Country:US
Practice Address - Phone:731-668-2277
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106101YM0800X
TN154106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist