Provider Demographics
NPI:1982878500
Name:GRAY, SARAH BETH (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:BETH
Last Name:GRAY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SNEAD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3008
Mailing Address - Country:US
Mailing Address - Phone:573-268-4646
Mailing Address - Fax:573-449-0338
Practice Address - Street 1:201 SNEAD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3008
Practice Address - Country:US
Practice Address - Phone:573-268-4646
Practice Address - Fax:573-449-0338
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional